5010, here we come

BALTIMORE - If all goes as planned, HME providers won't have to lift a finger when Medicare transitions to HIPAA version 5010 on Jan. 1, 2012, software vendors say.

That's because software vendors have spent a good part of this year, if not longer, updating their systems to meet the new standards for electronic claims submissions that must be used by health plans, healthcare clearinghouses and certain healthcare providers, they say.

"Eighty percent of providers are going to worry about this--they're going to say, 'I don't know what to do; I need to be trained,'" said Jay Williams, the western regional sales manager for QS/1, which, in June, was testing its new system. "But if the software vendors have done it right, it's going to be totally transparent. Providers are going to do things the way they've always done things."

As part of the transition, software vendors must also be tested and approved by the contractor for Common Electronic Data Interchange (CEDI), National Government Services.

Software vendors have put significant man-hours into rewriting their code and putting it to the test, they say. QS/1 has had two programmers working on updating its system. Brightree, already an approved vendor, has had eight, says CEO Dave Cormak.

"It has been a significant investment, but it's an important change," he said. "It will mean cleaner claims and better denial data coming back, which, in turn, means more cash and getting cash quicker for providers."

Those providers that use web-based systems will have the easiest transition of all, software vendors say.

"For clients on our hosted model, it will be totally transparent," said Spencer Kay, president of Fastrack Healthcare Systems, an approved vendor. "We'll just update the system at night and they'll be ready to go the next morning. For clients that have their own servers, they'll have to download the update from our website."

For more information, including whether your software vendor has been tested and approved, go here.

A boiled-down version of 5010

By Liz Beaulieu, Editor

Software vendors may be working overtime to make the transition to HIPAA version 5010 "transparent" for HME providers, but there are still a few things providers will want to know about the change, says industry consultant Andrea Stark.

Do you know your zip code plus four?

One of the "curve balls" that 5010 may throw providers: Instead of entering a patient's five-digit zip code, they'll have to enter a zip code plus four, says Stark, a reimbursement consultant with MiraVista.

"I don't know my zip code plus four," she said. "So that's something that providers, at intake, will have to obtain going forward."

Stark says providers should find out if their software vendor plans to make this easier by, say, building into their systems a database of zip codes plus four, so when an address is typed in, it populates that field.

Are you a code breaker?

Another difference, under 5010: Instead of receiving GenResponse Reports, providers will receive 277CA Reports, Stark says.

"These reports aren't going to be in plain English," she said. "They're not something that you can open up and read and they're formatted beautifully. They're going to be in code and your software vendor will have to translate them into readable reports."

Stark says the new reports are an attempt to make the process uniform across all payers and to increase the amount and sophistication of data collected.

Can you say ICD-10?

5010 helps to pave the way for a much bigger change for providers: The transition to a new version of diagnosis codes, called ICD-10, on Jan. 1, 2013. The new codes have seven digits vs. five digits, helping to make them more specific to a patient's condition, Stark says.

"So it's not just a patient with diabetes; it's a patient with diabetes who's insulin treated or who's Type 1 or who's Type 2," she said. "It's going to be completely different--not everything is going to have an exact match. So that's where it's going to get sticky."