5010 Compliance

Are you counting on an extension of the January 1, 2012 deadline for 5010 compliance? If you are, you will probably be very disappointed. With only a few weeks left to comply, it's very important for offices to realize that beginning in 2012, their claims are going to get rejected and it will cause cash flow problems unless they get up to speed quickly.

Fortunately, you can still take steps to prepare. If a practice hasn't done anything yet to comply with 5010, here's a quick checklist of things to do right away:

1) Call your software vendor to find out if they have completed the update for your billing software program to accommodate the required changes. If they have not, find out when it will be available because time is running out. If you are using a web-based "software as a service" vendor, they are likely to have already made the necessary changes, but verify this with them. If you use a billing service, find out what steps they have taken to comply. If you provide billing services, be prepared for your billing clients to ask what you’ve done to comply.

2) Check with your clearinghouse to see if they have already have tested claims with any other users of your software. If they have, there is a good chance your software has an update available to accommodate the required changes. You need to begin testing claim as soon as possible. Be prepared to work through issues and re-test if necessary. 

3) Contact your largest payers to find out if they have any issues you need to be aware of or if they have any contingency plans and what those might be. Even though CMS is telling payers they must reject 4010 claims after January 1, 2012, UHC confirmed during our conference that they could technically continue to accept 4010 claims. We don't know if they will, but the point was, they could and they were concerned that it could be a disservice to their insureds and providers to deny them.

Don't assume that your software vendor and clearinghouse will take care of testing for you. Doctors and other healthcare providers that have done nothing to comply with 5010 should prepare for cash flow issues. Even those that have tested and completed implementation should be prepared for technical glitches that might disrupt cash flow. 

Consider submitting as many transactions as possible before December 31, 2011 using your current system. If you have any backlogs of claims, get them in now! Also, you may want to get a line of credit established with your lending institution. And finally, if you experience problems with testing or getting claims paid after the January 1st deadline, drop your claims to paper until the problem has been resolved.