To state it simply, HIPPA 5010, or 5010 is a change to the protocol for the sending and receiving of claims data. The old set of standards known as 4010 has been in place for several years, and due to changes in healthcare, these standards require an upgrade.
The most important item to remember is that 5010 standards are effective on January 1, 2012. On that date, claims sent under the 4010 standards will be rejected. As a practice, what do you need to do in order to comply?
First, ensure that your practice management/billing software system is up to date. Keep on top of the software upgrades, and ensure that the vendor is going to have the compliant software in place. Find out if you will be required to purchase new software, or is it included with your maintenance agreements. The reason for this is basically because 5010 has changed how some fields are reported, and all of this information should be already captured in the practice management software.
Second, check with your clearing house to ensure that their plans for 5010 compliance are on schedule, and moving toward the end date. They may already have the software in testing ready, so you may by able to send some test claims to ensure that all of the data is going over correctly.
The biggest reason why you would want to take the steps is because 5010 is the requirement for the submission on the electronic claims data. It is not a change in CPT—4, or demographic data that you should be capturing in the practice management system. But 5010 is the first step in changing how we will be reporting diagnoses. On October 1, 2013, ICD—10 coding will be required.
ICD—10 is an enhanced version of ICD—9 coding, and the changes begin are very evident at first glance. ICD—9 codes are usually 3 characters, alpha/numeric possibly on the first digit, a decimal and 2 numeric codes following the decimal for increased specificity. ICD—10 codes will always start with an alpha character, two numeric characters, and then the decimal. After the decimal, then you may report up to 4 alphanumeric characters to indicate more data regarding the diagnosis. Based upon the complexity of this change, and what will be reported, you should take on the following actions:
- List together your up to 30 most common diagnoses now, and their ICD—9 coding.
- Engage your certified coder to create a tool with you to convert these codes to ICD—10 codes.
- Identify what will need to be chaned in your office, such as superbills, templates in your EMR, coding manuals, etc.
By taking these steps, you should be pretty well prepared for the changes that are occurring.