2011 Tech Survey: On 5010 Testing Day, ICD-10 Readiness Also in Focus

Note: This is the second in a series of blog entries delving into the results of our 2011 Physicians Practice Technology Survey. Full results of our latest technology survey are now available at www.physicianspractice.com/technology-survey. For more on the transition to ICD-10, check out our podcast “ICD-10 and Your Practice” with Rhonda Buckholtz, vice president of ICD-10 training and education for the American Academy of Professional Coders (AAPC).

There’s a big technology-related change on the horizon, and we’re not just talking about EHRs and meaningful use. In a little more than two years - on Oct. 1, 2013, to be precise - your practice will have to start seven-digit, alphanumeric ICD-10 codes. 

Did we mention there are a lot more of these codes than there are ICD-9 codes?

And though using ICD-10 codes is years away, the day you’ll have to implement Version 5010 of the Electronic Data Transactions standard is just around the corner. Version 5010 (also known, simply, as “5010”) is required for many future electronic transactions, such as processing insurance claims. It’s also required to support new, expanded ICD-10 code set. And by Jan. 1, 2012, all HIPAA-covered healthcare providers will have to start using it.

To draw attention to this important transition, CMS has christened June 15 (today) as “National Version 5010 Testing Day” for the HIPAA-mandated standard. (Note: For practices that can’t do this today, CMS is holding a second “Testing Day” Aug. 24).

To begin preparation, practices should be taking steps now to get ready, including conducting external testing to ensure timely compliance.

During last week’s virtual conference sponsored by Healthcare Information and Management Systems Society (HIMSS), more than one speaker stressed the importance of 5010 testing with vendor partners, as a key step in the ICD-10 shift.

“If you don’t comply with 5010 it’s going to hurt you,” said Richard Temple, an executive consultant for Beacon Partners, during the session "Planning for '5010”/ICD-10."

“It’s going to take a lot of work to rework transactions, your cash flow is going to be negatively impacted, and there’s also a fine of $50,000 if you don’t comply," he said.

During one point in the presentation, Temple halfway joked that healthcare organizations should actually “run away, seriously” if their software vendors answered no or wavered on the question “are you going to upgrade to 5010?”

However, a lot of practices aren’t quite ready for testing 5010, or switching to ICD-10, according to our research here at Physicians Practice. In our soon-to-be-released 2011 Technology Survey of physician practices, only 36 percent of respondents told us they think the software they use is ready for the coming transition to the ICD-10 code set. Forty-three percent said “no, but our vendor is promising an upgrade,” and 21 percent said “we’re not sure whether our current system will ever be upgraded to handle ICD-10.”
 

Though it’s not clear the extent to which vendors are to blame (many practices have told us their vendors are responsible for 5010 testing holdups), it is clear that CMS means business.

Now, the good news: Aside from the headaches of getting all your vendors and business partners on the same page, Temple noted 5010 will ultimately benefit healthcare organizations. The technology will allow for processing more detailed eligibility inquiry responses, better claim-status reporting, more robust authorization requests, improved detail on remittance records pertaining to denials, and smoother processing of secondary claims.

“Think of 5010 and how it relates to the larger [picture],” Temple said. “There are some good opportunities you’re going to be able to take advantage of with the advent of 5010.”