Majority of Physicians Unprepared for HIPAA 5010

Time is running out for medical providers to update to the new HIPAA Version 5010 financial system software and International Classification of Diseases 10th Edition (ICD-10). The first step in the process is the Version 5010 data-transmission standards upgrade, which the majority of practices are unprepared for.

According to a recent member survey by the Medical Group Management Association (MGMA), only one in 50 practices have completed the 5010 implementation.

Nearly half (45%) of the physicians who were surveyed reported their practices have not yet started Version 5010 implementation, with about the same number having partially completed implementation and only 2% having completed the implementation.

With the January 1, 2012 compliance deadline fast approaching, beginning the process is essential if physicians hope to avoid delays in claim reimbursements from Medicare and Medicaid in the future.

The switch to Version 5010 must occur before practices will be able to upgrade to the ICD-10 codes, which has an October 1, 2013 deadline. To make the transition as smooth as possible, the CMS recommends starting sooner rather than later.

“Unlike the current Version 4010/4010A1, Version 5010 accommodates the ICD-10 codes, and must be in place first before the changeover to ICD-10. The Version 5010 change occurs well before the ICD-10 implementation date to allow adequate Version 5010 testing and implementation time,” according to the CMS website.

Preparing for ICD-10 and Version 5010 – including potential updated software installation, staff training, changes to business operations and workflows, internal and external testing, reprinting of manuals and other materials, and more – will take time.”

While it’s not time to start panicking yet, providers certainly don’t want to wait until the holiday season to start their implementation process. When comparing the sheer number of codes in the new system, it’s probably best to get an early start on ICD-10 adoption.

Growth in codes from ICD-9 to ICD-10:
Diagnoses: ~14,000 to 69,000 (4x)
Procedures: ~3,800 to 72,000 (18x)
Totals: ~17,000 ICD-9 codes to ~150,000 ICD-10 codes

These numbers are a bit daunting, but it doesn’t stop there. Experts expect thousands of new modifiers, dozens of accumulators and hundreds of thousands of new benefit rules.

If you haven’t already started planning for the Version 5010 and ICD-10 upgrades, there is no time like the present. Save yourself from a mad scramble at the end of the year and start the process now.

Is your practice ready for Version 5010 and ICD-10? Let us know.



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