Is your practice ready?
5010 and ICD-10 vendor questions and guidelines
The federal government has mandated that all covered entities (including providers, clearinghouses, and health plans) must transition to the latest version of the Health Insurance Portability and Accountability Act (HIPAA) electronic transaction standards and code sets.
Jan. 1, 2012: 5010 version of the electronic transactions standards will replace the current 4010 version
Oct. 1, 2013: the International Classification of Diseases 9th Revision, Clinical Modification (ICD-9-CM), the current code set for reporting diagnosis, will be replaced by ICD-10-CM.
Physician practices are encouraged to begin their preparation for these two important changes as soon as possible in order to streamline the implementation process.
Where to start?
Questions for your practice management system (PMS) software vendor
PMS vendor checklist
Questions for your health plans
Before the 5010 and ICD-10 mandates take effect, your practice should:
- Identify and budget for required systems changes
- Software changes
- Increased system storage capacity
- Know if the necessary upgrades are covered by current vendor contracts
- Indentify for what upgrade costs your practice will be responsible
- Resource allocation to manage all requirements
- Administrative Simplification
- Meaningful Use
- Determine how best to take full advantage of these standards
- Claim (837) / Eligibility (270/271) /Claim status (278)
- Remittance (835) / Authorization and referral (277)
- Determine the preparedness of your vendors, payers, providers
- If 4010, NPI are any indication…
Critical 5010 and ICD-10 questions for your PMS software vendor
- Are you aware of these (and other) new government regulations?
- What is your schedule for 5010 and ICD-10 software upgrades/training?
- Will you be upgrading MY version of the software?
- If yes, what will be the cost for this upgrade?
- If not, what will be the cost for the version of the PMS software that will accommodate 5010/ICD-10?
- Will you be combining the upgrades for both mandates?
- Will you be offering any 5010 and ICD-10 training?
- (If a current or potential electronic health record (EHR) user) What modifications to my EHR must be made in order to accommodate 5010 and ICD-10?
- What type of EHR/PMS interface do you offer?
- Will I require additional hardware to support the software modifications to my PMS software? If yes, what will be required and what will these upgrades cost?
- Vendors identified
- Profiled with contact information
- Vendor contracts assessed
- Release schedule identified
- Staff training offered
- Consideration of trading partners
- Testing (theirs and yours)
- Implementation timeframes
- Deployment plan
- Electronic patient statements vs explanations of benefits
- All additional "go-live" factors
- When do you anticipate being ready to test each of the 5010 transactions?
- 837 (Professional Claim)
- 270/271 (Eligibility)
- 276/277 (Claim Status)
- 835 (Remittance)
- 278 (Referral Certification and Authorization)
- Will you be utilizing the CMS ICD-10 GEMs/crosswalks?
- When will you let us know about changes to coverage and payment due to ICD-10?
- Will you be offering any training or guidance regarding the migration to 5010/ICD-10?