5010 Deadline is Looming!

January 1, 2012 is closer than you think. If you haven’t had an opportunity to focus on the changes that are required for electronic claims effective on this date, you should make that your number one priority over the next 90 days to ensure no disruption in cash flow. This is critical because cash flow is already lower at the beginning of each year due to ‘deductible season.’

The AMA has listed the following steps to protect your cash in its “5010 Implementation Steps: Getting the Work Done in Time for the Deadline:”

• Submit as many transactions as possible before January 1, 2012.
• Decrease expenses before 1/1/12 to increase cash reserves.
• Consider establishing a line of credit with a financial institution.
• Research payers’ advance payment policies.
• Consider using manual or paper processes to complete transactions until the electronic transactions are fixed.

Note that the HIPAA standards, including Version 5010, are national standards and apply to your transactions with all payers, not just with FSS Medicare. That means you need to be prepared to implement these changes and transactions across the board.

Some improvements in Version 5010 electronic data transfer are:

• Standardized business information related to the transaction.
• Utilization of Technical Report Type 3 (TR3) guidelines that represent data consistently and are less confusing.
• More specific definition of the data that needs to be collected and transmitted.
• Accommodation of the reporting of clinical data such as ICD-10 diagnosis codes.
• Distinguishes between principal diagnosis, admitting diagnosis, external cause of injury, and patient reason for visit codes.
• Monitoring of certain illness mortality rates, outcomes for specific treatment options, some hospital length of stays, and clinical reasons for care.
• Addresses indicators on institutional claims for conditions that were “present on admission.”

If you can answer NO to any of the following questions, you are at risk for not being able to meet the January 1, 2012 deadline and not being able to submit claims:

1. Have you contracted your software vendor or billing agency to ensure they are on track to meet the deadline?
2. Have you identified changes to data reporting requirements?
3. Have you started to test files with software vendors, clearinghouses, or billing services?
4. Have you started testing with your MAC, which is required before being able to submit claims, with Version 5010?
5. Have you updated MREP software to view and print compliant HIPAA 5010 835 remittance advices?

Resources: MLN Matters Number: SE1131