CMS Puts Full Court Press On Providers to Meet 5010, ICD-10 Deadlines

After two years of preparation, the 5010 deadline is almost here. Providers such as physicians, alternate site providers, rehabilitation clinics, and hospitals, as well as health plans, clearinghouses and their associates are affected by the upcoming regulations. The health care providers have until January 1, 2012 to switch to the HIPAA 5010 transaction set and Llter next year, looming behind the initial HIPAA 5010 deadline,is the October 1, 2013 deadline for the changeover to the ICD-10 diagnostic code set.

These versions are required by the modifications made to the Health Insurance Portability and Accountability Act of 1996 (HIPAA) in January 2009. Version 5010 is the new version of the X12 standards for HIPAA transactions; Version D.0 is the new version of the National Council for Prescription Drug  Program (NCPDP) standards for pharmacy and supplier transactions; and Version 3.0 is a new NCPDP standard for Medicaid pharmacy subrogation.

CMS is counting down the days on its website, has been using everything from emails to national provider phone calls to get providers ready to meet the January 1 deadline, and now it’s time for the last push. CMS has several educational resources available for providers, which are designed to increase national awareness and assist in the implementation of Versions 5010, D.0 and 3.0. On October 4, CMS released a Medlearn Matters article, with special attention for any provider lagging behind in the process.

A list of questions is provided to determine whether a provider is in danger of missing the deadline. Providers should ask themselves:

  • (1) whether you’ve contacted your software vendor (if applicable) to ensure that they are on track to meet the deadline or contacted your MAC to get the free Version 5010 software (PC-Ace Pro32) or whether you’ve contacted clearinghouses or billing services to have them translate your Version 4010 transactions to Version 5010 (if not converting your older software);
  • (2) whether you’ve identified changes to data reporting requirements;
  • (3) whether you have started to test with your trading partners, which began on January 1, 2011,
  • (4) whether you have started testing with your MAC, which is required before being able to submit bills with the Version 5010; and 
  • (5) whether you have updated MREP software to view and print compliant HIPAA 5010 835 remittance advices. If a provider can answer no to any of these questions, consider yourself in danger. Advice is available on the CMS website on ways to get back on track.

There’s an excellent tool CMS is using to assist in providing a timeline and list of resources related to the implementation of HIPAA Versions 5010 and D.0. At your fingertips is a list of CMS resources, additional provider resources, and a timeline for providers to gauge compliance at various points in the process. There’s also a checklist to a smooth transition, which encourages providers to:

  • (1) engage vendors early;
  • (2) communicate with clearing houses, billing services and payors;
  • (3) identify changes in data reporting requirements;
  • (4) identify possible modifications to current workflow and business processes;
  •  (5) identify staff training needs; and
  • (6) test with your training partners.

CMS has a dual role related to the Version 5010, D.0 and 3.0 standards.  The CMS Office of E-Health Standards & Services (OESS) is responsible for the policies and enforcement of the Administrative Simplification provisions for transactions and code sets and the National Provider Identifier (NPI) covered under HIPAA.  Other areas within CMS are responsible for systems and operations related to CMS’ role as a payer of healthcare claims for the Medicare and Medicaid programs, including Medicare Fee-For-Service (FFS), Medicare Advantage and Prescription Drug Plans, and Medicaid Coordination of Benefits.

Comments

  1. Hi Jenny M. Burke, this article is super!  It clearly identifies and outlines the realities of the upcoming EDI / ICD-10 / HIPAA 4010 to 5010 conversion challenges. I work with a U.S. based strategic services company (headquartered in NY and with operations in India).  At the moment we are working with over 20 payer/provider companies, most of which we have already successfully converted them to 5010.  Even with our 10+ years of experience in the healthcare back office space, I’ve seen that with each conversion that new lessons are learned by our team on client specific peculiarities…and our process is now well matured. However, as time is growing short I think we are all starting to see more and more companies literally rushing now to ensure that they are ready to start submitting their claims electronically using the X12 Version 5010 and NCPDP Version D.0 standards by the January 1st 2012 deadline.  We’ll keep checking back to see if you have any updates and suggestions for the industry.  Cheers, Angela Carson, Head of Communication at Vee Technologies