Preparedness within the health care industry should always be a priority, yet many providers depend on their office administration, IT support, or software vendors to keep them current with annual updates directly affecting their practice.
In the past, internal problems that may have developed due to negligence required minimal adjustments to get the workplace flowing again. However, implementation of Version 5010 and the transition from ICD-9-CM to ICD-10-CM will not be an easy fix should a provider assume a wait-and-see attitude toward these significant changes slated for October 1, 2013. The “go live” date for 5010 is much closer, at January 1, 2012.
For some providers, 2013 is too far into the future to contemplate. For others, Version 5010 is an issue, as it is a concept which is not clearly understood, resulting in deficient planning. Unlike previous changes that have occurred in health care, there will be no grace period with the transition to Version 5010. Without preparation, practices will experience unrecoverable financial loss, particularly with health plans that impose filing limits.
To understand Version 5010 and its relationship within a medical practice, review the following electronic transactions that most providers utilize. Keep in mind that 5010 is the only version that will accommodate ICD-10-CM’s size of 3 to 7 alpha-numeric character spaces and its complexities for submission standards.
- Electronic Claim Submissions and Remittances
- Electronic Referrals and Authorizations
- Electronic Eligibility Inquiries
- Claim Status Inquiries and Claim Adjustments
- Coordination of Benefits
- Clearinghouse Communication
- Practice Management Software
- Electronic Medical Records Utilization and Interaction with Practice Management Software
Providers may not comprehend the internal improvements with the transition from Version 4010 to Version 5010, but planning ahead and budgeting for the future now is the only solution to health care’s upcoming changes.
It is only by working hand in hand with our vendors and testing often and early that we can identify any issues we may have and take the necessary actions to be sure our revenue is not interrupted. The Centers for Medicare & Medicaid Services (CMS) are declaring the week of August 22 as a national testing week; be sure to join in and test with your vendors.