As is fairly typical, industry focus on Version 5010 of the electronic transaction standards has waned a bit as new rules and regulations steal the spotlight. But I’d like to urge you not to let your 5010 transition plans get waylaid by other priorities—January 1, 2012 is only slightly more than 14 months away. That’s not much time for a conversion of such far-reaching magnitude.
By this time, you should have a pretty thorough understanding of exactly what the 5010 transition will mean to your practice’s daily operations. But avoiding cash flow interruptions during—and immediately after—the transition to 5010 should remain a paramount concern. I recommend that practices take the following steps to minimize potential disruption:
- Create an implementation plan. This should include a timeline for analyzing internal systems; discussing transition requirements with vendors and payers; updating HIT software; training staff; testing; and monitoring.
- Work with HIT vendors to determine what steps need to be taken to make the transition. Ask your vendors when they plan to be ready to accept 5010 transactions. In addition, find out whether they’ll be able to handle both 4010 and 5010 transactions “just in case.”
- Communicate with payers you work with directly about their 5010 plan. Ask these payers the same questions you ask your vendors. Note that in many cases, vendors will handle all aspects of testing with each payer, thus freeing you from that responsibility. However, if your practice works directly with any payers, it is important that you test with these organizations.
- Obtain testing schedules from all HIT vendors, and be prepared to devote staff time and resources. Some vendors, though, will not require each practice to test with them. Instead, these vendors will test directly with practice management vendors or a select group of practices having varying practice management software systems—whichever ensures an accurate assessment of readiness. In such cases, the transition should be automatic and invisible to practices.
- Update all HIT software to recognize 5010. It’s also advisable to find out early on whether the transition to 5010 will require you to purchase software updates from your HIT vendors. In particular, 5010 changes some aspects of the 835 remittance/payment data and 271 eligibility response, so these transactions may require software updates.
- Train staff on the 5010 transition. Consider beginning the training process about 6 months ahead of the January 1, 2012 implementation date.
- Test or verify that all necessary system updates are completed and that critical HIT vendors have communicated their readiness for 5010. Be sure to verify that your partners understand what your systems require to continue operating correctly.
- Monitor operational data files to ensure solutions are working properly. Some vendors will offer tools to monitor rejections, denials, and other files to help verify transactions and pinpoint potential problems.
Version 5010 promises to standardize electronic transactions among all healthcare entities, thus improving claims filing, payment posting, eligibility verification, and other vital revenue cycle management functions. Just make sure you’re taking all the steps necessary to be prepared for the transition on time; if you are not prepared, your claims will be rejected by insurance carriers.
For a few more education and preparation tips, download this free white paper as a resource guide.