The recent proposal to delay the implementation of ICD-10 by one full year has received a mixed response from healthcare organizations. Many hospitals and medical practices that had started working on the transition (and were making progress) are frustrated by the delay. They fear it may halt momentum and slow forward movement. Conversely, many of those organizations that had not begun work are relieved by the date change—and glad they had not started preparation efforts in earnest.

Regardless of whether your practice is frustrated or relieved by the delay, the implications will be the same: You should anticipate some changes to your implementation plan. While the steps involved in completing the ICD-10 transition project will remain the same— for example, assessing your practice’s current ICD-9 use, mapping codes, upgrading software, educating physicians and staff, and testing—the deadlines for these efforts will change. Practices need to review and re-evaluate both internal deadlines and external ones, such as those agreed upon by vendors and payers.

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This past Monday, the Department of Health and Human Services (HHS) proposed that the ICD-10 implementation deadline be extended one full year to October 1, 2014, as opposed to the original October 1, 2013 deadline.

Multiple provider groups had expressed concerns to HHS about meeting the original compliance deadline for ICD-10. The extra year would give these providers and other covered entities more time to test and prepare their systems to help ensure a smoother transition.

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I’m a firm believer in learning from every opportunity that presents itself. The 5010 transition is one such golden opportunity, especially for payers.

In looking at how payers have responded to the HIPAA 5010 implementation, I’d say performance has been mixed. On one hand, many larger payers have been on top of the numerous technical aspects of 5010 and have been quite persistent in reaching out to clearinghouses and practices. They have done a good job getting ready, technically speaking, well in advance of the different conversion dates.

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Last week, the Centers for Medicare & Medicaid Services (CMS) announced they would once again delay enforcement of HIPAA 5010 standards – this time until June 30, 2012. The decision came after an assessment of industry experiences with the 5010 transition, including a letter sent by the MGMA-ACMPE^® to CMS requesting the enforcement deadline be extended because many of their association members were not ready. Among the reasons for their request was the fact that many practice administrators are still reporting significant delays in claim payments.

While not everyone has made the transition, CMS announced that many organizations – health plans, clearinghouses, providers and other technology vendors – have made significant progress towards transitioning to the new required HIPAA EDI standard. They anticipate that 98% of claims submitted by June 30^th will be 5010 compliant.

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The arrival of the 5010 electronic claims transaction standard has created quite a few questions in regard to the proper use of National Drug Codes (NDCs). Here are the answers to some frequently asked questions.

Question: I’ve heard conflicting requirements regarding NDC reporting—some only want NDCs on “not otherwise specified” codes (e.g., J3490). However, I’ve also heard that NDCs are necessary on every drug. Could you clarify?

Answer: NDCs are not required for every drug. The 5010 specification says NDCs are used: 1) when the government mandates it (e.g., for rebate programs) or 2) when you choose to report them to enhance claim reporting/adjudication. Many times a HCPCS code adequately describes the drug in terms of description, quantity and measurement type. However, for certain non-specific J codes like J3490, including either an NDC or a description likely would result in better claim processing.

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As practices begin working on the transition to ICD-10, more and more questions are emerging every day. Here’s a look at four Frequently Asked Questions (FAQs), with answers to help you prepare:

FAQ: What is the difference between ICD-10-PCS codes and ICD-10-CM codes?

ICD-10-CM codes are diagnosis codes. They are defined globally by the World Health Organization (WHO), but are modified for use in the United States by the National Center for Health Statistics (NCHS). Most professional, outpatient and ambulatory practices will use ICD-10-CM codes.

By contrast, ICD-10-PCS codes are procedure codes. These codes are created by the Centers for Medicare and Medicaid Services (CMS) and are only used on inpatient, facility-based claims. Ambulatory practices will continue to use CPT procedure codes, just as they do now, when ICD-10 takes effect.

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Thank you to everyone who attended our latest webinar on February 15, 5010: The Good, the Bad, and the Ugly. Ken Bradley, Vice President of Strategic Planning at Navicure, led the one-hour event, which focused on how the new HIPAA 5010 electronic standard. During the webinar, he offered advice about:

• How to leverage 5010 to improve business processes.
• The most common 5010 errors and how to avoid them.

To learn more about how to leverage 5010 effectively so your revenue cycle remains healthy, click here to download this webinar.

This program meets AAPC guidelines for 1.0 Core A or 1.0 CPCO specialty CEUs. On Demand product requires successful completion of a Post-Test for continuing education units. Granting of prior approval in no way constitutes endorsement by AAPC of the program content or the program sponsor.

There are a number of laws and regulations your practice must strictly follow to ensure it is fully and accurately reimbursed for patient care services. These laws and regulations not only monitor payment accuracy, but are also in place to prevent fraud and abuse and to preserve patient privacy and security. If you don’t always comply with them, you risk your revenue cycle being impacted – or worse being fined. You simply can’t afford not to be in compliance.

The vast majority of physician practices strive to be compliant and can attest to the huge challenge behind the effort. This is because keeping up with the constantly changing laws and regulations, along with the updates to medical necessity, requires a significant amount of staff resources that many practices simply don’t have. It is not surprising that medical necessity almost always ranks among the top 10 causes of Medicare denial, especially given how frequently payer policies and National Correct Coding Initiative (NCCI) edits change.

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A few weeks ago, I spoke with the editor of ICD-10 Watch about how the transition to the new HIPAA 5010 electronic transaction standard went. Since the 5010 compliance deadline earlier this month, healthcare payers have had to learn to manage and respond to unexpected problems with medical claim rejections and denials. We discussed some of the specific problems that may be causing issues for practices, as well as the importance of tracking claims to ensure the reimbursement that practices receive is what they anticipated.

After our discussion, the editor wrote an article that summarized our discussion and the most common 5010-related problems practices are experiencing, along with the correction to these problems. You can read the full article here to learn more.

On January 1, 2012 HIPAA 5010 became the new required standard for electronic transactions. Are you wondering how to leverage the new 5010 standard effectively while ensuring your revenue cycle remains healthy?

Join us on Wednesday, February 15^th at 1:00 pm EST, for a complimentary webinar, 5010: The Good, the Bad, and the Ugly. Register Now.

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