Jackie Griffi n, manager of training and project
implementation, Gateway EDI HIPAA 5010 will improve practice
profi tability by increasing the speed and accuracy of the claims submission process in several ways, including: Standardizing claims formats across the industry to simplify today’s complex claims submission process. With the current 4010 format, local variations of formats create opportunities for data-entry
p a p
errors that can delay or deny payments. ors that can delay
Making the language and defi nitions of claim entry information clearer and consistent across all payers to reduce the effort required by those processing
the claims. Today, language is left up to individual interpretation, which slows down the process and can cause errors. Removing redundant data entry. With 4010, you are
required to send data at both the claim and service line level. The new 5010 format removes these redundancies, so you only need to report them once. The result is a more streamlined claims submission process that requires less staff time and provides faster turnaround on payments. All of these changes bring effi ciencies that will get you paid faster and reduce administrative costs. Of course, some of you may be concerned about the additional up- front time needed for your staff to make the transition and get comfortable using 5010. However, once your practice is up and running on 5010, your staff will be freed up for other activities, such as strengthening customer service, which will make your practice more competitive in the post-healthcare reform environment.
Steven ZoBell, VP of product
development, ADP AdvancedMD One of the biggest challenges with the HIPAA 5010 migration is the fact that payers and providers both have to be ready to receive and submit claims, respectively, on the same date of Jan. 1, 2012. With past initiatives, such as NPI, providers and payers had a transition period when they could each respectively test their systems. With 5010, payers
will be dealing with their potential issues at the same time providers are dealing with theirs. This matters to a practice because when a claim fails to go through, it could be diffi cult to know in which system the problem lies. This could likely result in a delay in payment while all parties trace the fl ow of data. A greater implication for providers using a legacy client/server system is that this transition could bring their cash fl ow to a dead stop. As we are only two months from the deadline, if a system has not yet been upgraded to 5010 compatibility, there is a very real chance it won’t be upgraded in time. Not only could these providers have to hold claims after the deadline while waiting for their system upgrade, but each day they hold a claim gets them one day closer to missing the fi ling time limits. With cloud-based software, this challenge is not present; the software typically has regular updates for additional features and functionality, including regulatory changes such as HIPAA 5010 compliance.
Deborah Robb, BSHA, CPC,
physician services director, TrustHCS As with any change, things always get worse before they get better; HIPAA 5010 is no exception. Time and resources will be required for the project. This will affect small practices to a greater extent due to the resource limitations. Practices will also see their margins squeezed in the short run and should prepare for this fi nancially. Practices that go beyond the
required changes and alter their workflow will find long-term efficiencies to streamline claims-management processes and enhance revenue cycles. Planning should be well underway in three key areas: information systems, training and budget. Information systems from practice-management vendors, clearinghouses, billing services, EHRs and reporting systems should have already been evaluated for 5010 compatibility and upgrade costs identifi ed. All the changes must be tested to assure no cash-fl ow impact on Jan 1, 2012. Practices must identify who needs to be trained and to what extent. There will be staff downtime for training affecting productivity. End-to-end training with all partners is essential, including software vendors, payers and clearinghouses. Budgets will need to be beefed up on the expense side for implementation costs, systems changes, resource materials, testing, consultants and training. Also, it is important to have a back-up plan in case transactions do not work in order to mitigate disruptions to the revenue stream. The bottom line is that HIPAA 5010 will reduce practices’ bottom lines – at least in the short run.
HEALTH MANAGEMENT TECHNOLOGY November 2011 7