A boiled down version of 5010

Thursday, August 25, 2011

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."