CMS is preparing to test electronic claims transmission using the new 5010 HIPAA standard -- a secure electronic format that all your software must use. This will impact your practice management software, your electronic health record (EHR) system if you have one, and your clearinghouse, if you use one.
Remember: All claims must be transmitted using the 5010 standard, rather than the current 4010 standard,
starting Jan. 1, 2012. This change spans all health plans bound by HIPAA, which basically means
you've got to comply not just for Medicare, but for private payers as well.
One piece of
advice you've been getting from CMS and us is to
call your vendor and make sure they're ready. Well, at least one vendor has a letter explaining their 5010 transition plans, which they sent to me last week. Here is what eClinicalWorks has to say about the transition. If you are using their software, this gives you a great idea of what to expect. If not -- their answers are the ones you want to get out of your vendor.
"eClinicalWorks developers spent a good part of 2010 preparing our unified EMR/PM for the coming transition to 5010. We’re committed to ensuring that all clients will be able to comply as trading partners on January 1, 2012 without interruptions to cash flow. Our analysis of both the base 5010 formatting and available errata is complete, as are the necessary programming changes to accommodate the new electronic claim formats, and internal testing has gone well. Readiness communication with our partner clearinghouses is ongoing and across the board; they have relayed assurances that they will be able to convert data in either format based on payer readiness.
Our plan is to begin end-to-end testing with the assistance of select customers beginning this first quarter of 2011 and accelerating beginning in April, when Medicare is ready to test errata. We are currently assessing how best to handle our customers who do not use one of our partner or preferred clearinghouses; those who are submitting directly to payers today. Though testing with some 100 or so payers will be resource and time intensive, at this time, we expect to undertake that challenge and begin after testing with Medicare is complete.
At this time, extensive company-wide efforts are underway to release our Meaningful Use certified version to all customers, especially those with plans to attest early this year. The good news is that, although hidden for now, Version 9 (our latest version) includes our 5010 work to date. We’re hopeful that customers will not need to upgrade again before year’s end, and that any new development required as a result of end-to-end testing will be made available through patches."