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What’s Next with 5010 Implementation

Later this month, the Centers for Medicare & Medicaid Services and the Medicare FFS Program will host their second National Version 5010 Testing Day, which will encourage technology vendors and medical practices to test their preparedness for 5010. With that theme and spirit in mind, we wanted to provide you with a list of items you should talk to your technology vendors about to ensure that the 5010 transition is as seamless as possible:

  • Are they working with payers? You will want to confirm that your technology vendor is submitting test claims to fully understand what each payer requires—and that they will share that information with your practice. In addition, vendors should be coalescing information obtained from and about payers, making sure this information is available for review, and being utilized to ensure a smooth transition.

  • Will they be educating you about necessary changes? In my opinion, technology companies should regularly communicate with their clients to ensure they know how to become 5010 compliant. For example, one clearinghouse has started implementing warnings tied to certain potentially troublesome parts of the claim—such as the incorrect use of post office boxes or practice zip codes. Although warnings won’t stop claims from being forwarded for payment at this point, they will show providers what needs to be changed to ensure clean claims going forward.
  • Will they be checking in with other vendors? In addition to payers and clients, all technology vendors should be communicating with other vendors (such as EHR or practice management companies) to make sure everyone is on the same page as we head toward the implementation deadline. One company in the industry is surveying vendors about how practices can make changes to support compliance—and then sharing the results with their clients.
  • Are they looking beyond claims submission? As January 2012 looms, there are other aspects of 5010 implementation besides just claims submission that need to be considered—including how it will affect remittance, payer response, and eligibility. With the focus, up until now, primarily on claims submission, many practices haven’t started to consider these other potential issues, yet they could drastically alter a practice’s revenue cycle. Going forward, ask your vendors if they have started working on these areas to make sure your revenue is not in jeopardy.

Although these are certainly not the only items that you should be asking about, it is a good starting point to ensure that your technology vendors are on track to be ready for January 1, 2012.