Medical practices face two significant deadlines that require planning and testing in 2011. The first deadline, January 1, 2012, is for the adoption of a new standard — the 5010 standard —for electronic claims transactions. This change must be made to accommodate regulatory changes in core billing processes such as claims submission and remission, claim status inquiry, eligibility inquiry, and transaction acknowledgment. The second deadline is the long-awaited (or long-dreaded) deadline for moving from the ICD-9 to the ICD-10 code set. This deadline is slated for October 1, 2013. In addition to changes physicians and other providers will have to make in recording diagnoses and procedures, the move to ICD-10 will require extensive re-programming and testing of practice management systems, revision of encounter and testing forms, and numerous other changes.It is critical that practices be ready for these two deadlines. Failure to prepare for either could bring a practice to its operational — and financial — knees. The following is an overview of these two transitions provided by CMS.
About the Version 5010 Transition on January 1, 2012
On January 1, 2012, standards for electronic health care transactions change from Version 4010/4010A1 to Version 5010. These electronic health care transactions include functions like claims, eligibility inquiries, and remittance advices. Unlike the current Version 4010/4010A1, Version 5010 accommodates the ICD-10 codes, and must be in place first before the changeover to ICD-10. The Version 5010 change occurs well before the ICD-10 implementation date to allow adequate Version 5010 testing and implementation time. If providers do not conduct electronic health transactions using Version 5010 as of January 1, 2012, delays in claim reimbursement may result. If health plans cannot accept Version 5010 transactions from providers, they may experience a large increase in provider customer service inquiries affecting their operations.Preparing for ICD-10 and Version 5010 – including potential updated software installation, staff training, changes to business operations and workflows, internal and external testing, reprinting of manuals and other materials, and more – will take time.
About the ICD-10 Transition on October 1, 2013
ICD-10 codes must be used on all HIPAA transactions, including outpatient claims with dates of service, and inpatient claims with dates of discharge on and after October 1, 2013. Otherwise, your claims and other transactions may be rejected, and you will need to resubmit them with the ICD-10 codes. This could result in delays and may impact your reimbursements, so it is important to start now to prepare for the changeover to ICD-10 codes.This change does not affect CPT coding for outpatient procedures.