Can you hear that clock ticking down to Jan. 1, 2012? If you are among the few in healthcare who are really on the ball, becoming compliant with new ASC-X12 5010 transaction standards ahead of the deadline, then congratulations! A big weight is off your shoulders.
But for the majority of the industry, this is your wake-up call. Almost three years after the Department of Health and Human Services (HHS) published 5010 as a replacement for the outdated 4010 standard covering all HIPAA-related transactions between physicians, hospitals, payers, clearinghouses, pharmacies and dentists, it all comes down to the next month filled with billing software upgrades, staff training and system testing.
Don't be too hard on yourself if you still have work to do to complete the transition to 5010. You've been understandably busy with a litany of activities, including deploying technologies that comply with the HHS meaningful use guidelines and prepping for that other ominous date – Oct. 1, 2013 – the deadline for conversion to the ICD-10-CM and ICD-10-PCS billing code sets. Of course, the Errata issued by ASC-X12 in 2010 also caused some delay. The Errata required changes from both payers and providers, and offset some early efforts of implementation.
Not to mention your IT staff is likely stretched thin and costs are mounting. Even state Medicaid systems are said to be a little behind for the transition, plagued with many of the same issues you currently face. But 5010 is looming large, so let's all roll up our sleeves and get to work.
First, understand that the transition isn't just a way of making our lives miserable. While the 4010 standard represented a great first step into the world of electronic transactions, our ever-progressing industry demanded a new set of standards to accommodate diverse business challenges and requirements, including compliance with upcoming ICD-10 code sets. Among the differences between the two standards, 5010 addresses new-use cases brought forward by the industry, clarifies usage to remove ambiguity, provides consistency across all transactions and supports the National Provider Identifier standard.
Also, realize that there are scarce resources and limited time to complete the transition. While most clearinghouses will likely be able to adjust to the 5010 standard easily, payers and providers have to make significant, time-consuming changes to their transaction and billing systems. Organizations should examine diverting clinical and IT expertise devoted to other projects to address issues with the 5010 conversion. Also, healthcare providers should consider bringing in a professional services team that's well versed on the new standards.
Many organizations have taken the upgrade into their own hands by purchasing a "solution in a box," only to find it does not met their business needs. In this way, they are relying on software written by programmers who have little to no actual knowledge of the many nuances involved with the 5010 conversion – including testing activities in which many rules will need to be turned off according to specific payer requirements. In most cases, staff will need to be involved throughout transition process.
Know that help is available. Fortunately, many vendors handling Electronic Data Interchange (EDI) have ensured that their services have been enhanced to facilitate the new transaction standards. In addition, select companies have shared in-depth gap analysis for all supported transactions to customers and have provided an implementation roadmap to help organizations with the transition. As a precaution, payers and providers alike should check with clearinghouses to ensure they are prepared to accept 4010A1 from submitters and convert it to 5010 for payers that are ready, while continuing to send in 4010A1 for payers still using that format. Select clearinghouses, such as Emdeon, will be offering this service to their clients to help ease through the transition.
Finally, just last month, CMS announced that although the compliance date for 5010 standards remains January 1, 2012, the Office of E-Health Standards and Services (OESS) would not initiate enforcement action until March 30, 2012. What does that mean? Some people have embarked on 5010 and realized that it is taking more time than originally forecasted. CMS recognizes that delay but still recommends proceeding towards the fast approaching January 1 compliance deadline. It's not too late to ensure your organization is HIPAA 5010 compliant.
Debbi Meisner is the vice president of regulatory compliance strategy for Emdeon. She also sits on the WEDI Board of Directors, is a co-chair for the Health Care Task Group of ASC-X12 Insurance Subcommittee and a liaison for the National Uniform Bill and Claim Committees.