Beginning on Jan. 1, 2012, providers must use the new HIPAA 5010 transaction standards to conduct certain administrative transactions such as claims, remittance, eligibility and others, but with so many providers unprepared for the 5010 transition, ominous clouds could be coming over the ICD-10 transition as well, according to several healthcare consultants.
John Pitsikoulis, strategic advisory services client executive for CTG Health Solutions; Stanley Nachimson, principal of Nachimson Advisors; and Denise Nash, MD, medical director of B2B and payor technologies for MedAssets recently spoke in a "Talk Ten Tuesday" webinar sponsored by ICD10monitor discussing the approaching deadline of 5010 and what its implications will be.
Mr. Pitsikoulis explained that as the 5010 deadline approaches, there's naturally a lot of activity as providers scramble to upgrade their systems. However, based on CMS' National 5010 Testing Week last week and from his current observations, he is surprised at how many organizations are beginning their mitigation plans for 5010 with only four months remaining.
Provider mitigation plans typically involve a two-tier approach, he says. Testing of the billing systems to ensure submitting claims is smooth and testing of secondary systems that aren't integral to the billing process must be completed. However, some providers are struggling to manage multiple initiatives — ranging from 5010, ICD-10 and other general healthcare reform proposals. This struggle is leading to a lack of centralized strategic planning and is therefore not keeping 5010 implementation on track. "Everyone has competing priorities and resources," Mr. Pitsikoulis said. "My concern is that if we follow this same path with ICD-10, there will be a domino effect, and there will be problems."
HIPAA 5010 standards will immediately change the way both hospitals and physicians submit data in claims, Dr. Nash says. For example, physicians must now submit a nine-digit zip code, and they must submit a patient's street address — P.O. boxes are no longer acceptable. These new 5010 standards are going to demand more specificity of data and a more efficient, upfront claims process in order to lower the need to re-file claims, she says. However, external testing of these standards is not yet widespread.
These electronic standards will impact revenue for any type of provider, but Mr. Nachimson thinks a lot of providers do not realize how deep it will impact their cash flow and should not expect any type of postponement in the deadline. Instead, for those who have not had their systems upgraded or have not conducted any 5010 testing, emergency steps need to be taken. Providers need to talk with vendors, billing services and clearinghouses to assist them in this transition if they are late to the 5010 party, but he says there could be a caveat. "They may not be able to take on new customers" because of their workloads, he says. Additionally, providers should be aware of, and also prepare for, new HIPAA standards and changes that will be coming out in the next three to four years under the Patient Protection and Affordable Care Act.
Coordination is not always easy between providers, vendors and payors, but 5010 is only the beginning of the healthcare industry's new long-term billing and coding preparations. "It's critical for organizations to learn what worked and what didn't work with 5010 to apply it to ICD-10," Mr. Nachimson says. "This process of managing transition is something that all providers need to have in their long-term planning."
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John Pitsikoulis, strategic advisory services client executive for CTG Health Solutions; Stanley Nachimson, principal of Nachimson Advisors; and Denise Nash, MD, medical director of B2B and payor technologies for MedAssets recently spoke in a "Talk Ten Tuesday" webinar sponsored by ICD10monitor discussing the approaching deadline of 5010 and what its implications will be.
Mr. Pitsikoulis explained that as the 5010 deadline approaches, there's naturally a lot of activity as providers scramble to upgrade their systems. However, based on CMS' National 5010 Testing Week last week and from his current observations, he is surprised at how many organizations are beginning their mitigation plans for 5010 with only four months remaining.
Provider mitigation plans typically involve a two-tier approach, he says. Testing of the billing systems to ensure submitting claims is smooth and testing of secondary systems that aren't integral to the billing process must be completed. However, some providers are struggling to manage multiple initiatives — ranging from 5010, ICD-10 and other general healthcare reform proposals. This struggle is leading to a lack of centralized strategic planning and is therefore not keeping 5010 implementation on track. "Everyone has competing priorities and resources," Mr. Pitsikoulis said. "My concern is that if we follow this same path with ICD-10, there will be a domino effect, and there will be problems."
HIPAA 5010 standards will immediately change the way both hospitals and physicians submit data in claims, Dr. Nash says. For example, physicians must now submit a nine-digit zip code, and they must submit a patient's street address — P.O. boxes are no longer acceptable. These new 5010 standards are going to demand more specificity of data and a more efficient, upfront claims process in order to lower the need to re-file claims, she says. However, external testing of these standards is not yet widespread.
These electronic standards will impact revenue for any type of provider, but Mr. Nachimson thinks a lot of providers do not realize how deep it will impact their cash flow and should not expect any type of postponement in the deadline. Instead, for those who have not had their systems upgraded or have not conducted any 5010 testing, emergency steps need to be taken. Providers need to talk with vendors, billing services and clearinghouses to assist them in this transition if they are late to the 5010 party, but he says there could be a caveat. "They may not be able to take on new customers" because of their workloads, he says. Additionally, providers should be aware of, and also prepare for, new HIPAA standards and changes that will be coming out in the next three to four years under the Patient Protection and Affordable Care Act.
Coordination is not always easy between providers, vendors and payors, but 5010 is only the beginning of the healthcare industry's new long-term billing and coding preparations. "It's critical for organizations to learn what worked and what didn't work with 5010 to apply it to ICD-10," Mr. Nachimson says. "This process of managing transition is something that all providers need to have in their long-term planning."
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One-Third of Healthcare Providers Not Ready for 5010