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With 5010 Over, What’s Next?

It’s July, and that means hot dogs, fireworks and the end of the 5010 transition. Or does it? Now it’s time to consider how your practice can leverage 5010 data and prepare for the next transition.

While almost all payers are processing claims in 5010 with no difficulty, there are a handful of payers that are still not ready for the transition. Your practice should be prepared for stragglers, maintain awareness of which payers are having challenges and keep lines of communication open. Noncompliant payers will be eager to make the transition to 5010—since the Centers for Medicare and Medicaid Services (CMS) will start enforcing it—and so they could change their claims submission and payment remittance processes quickly without much notice.

I also recommend continuing to monitor and respond to rejections and denials just as you have been since January. As I’ve mentioned in earlier blogs, rejections and denials are clear indicators of possible problems, and changes in these indicators will alert you that something is amiss.

It may also be helpful to look at some of the issues you struggled with after the January and April implementation dates. These same hiccups could present themselves again with different payers, so anticipating and addressing them proactively can help you finish the 5010 transition faster.

Keeping an eye on possible 5010 glitches, you can now turn the bulk of your attention to the future and leverage some of the new found capabilities that come with 5010. For example, proactive and comprehensive eligibility verification is a reality now, and all practices should be engaging in this effort. Such verification allows you to understand patient responsibilities, current primary insurance coverage and any secondary coverage upfront. The most frequent claim rejections relate to patients not having insurance. By performing a real-time or batch-level eligibility check, your practice can make a significant dent in these types of rejections!

On the remit side, there are some new data requirements and business usage rules related to corrections and reversals, overpayments and denials. Your organization’s practice management system should be able to handle the new data requirements and capabilities and payers should be now be operating in accordance with both the data and business rules – together, these provide opportunities to further automate your revenue cycle. If your system cannot do this, you should find out why and work with your vendor to correct the situation.

Finally, it is important to be aware of other large-scale implementation projects on the horizon, such as the new standard unique health plan ID number enumeration that begins October 1, 2012. While this implementation may not have a huge impact on your practice, it is something to keep on your radar. Practices should communicate with their payers about when they will start using the ID number and plan accordingly.