According to Buenning, all vendors of billing services and programs should have already concluded internal testing and be ready to start external dry runs between the provider, clearinghouse (if used), and payor. CMS’ Medicare Fee for Service Program began to accept test claims with the basic Version 5010 standards as of January 1 and will continue to pay claims submitted using the current Version 4010/4010A standards until December 31, 2011. CMS expects to accept claims in production using the errata Version 5010 standard in April of 2011.
Testing Should Start Now
The experts interviewed here suggest that practices immediately contact their practice-management system software vendor to find out when and if they will be updating their software to allow the practice to use Version 5010 standards in external testing with their health plans. Depending on how a specific practice is structured, they may also need to check with other vendors such as its electronic health record company to address compatibility issues.
The experts also strongly suggest that practices start sending test transactions to health plans and clearinghouses as early this year as possible so that there is adequate time to iron out problems before the end of 2011. Otherwise, there is a risk that the practice will not get paid until their systems are in compliance with the Version 5010 mandate.
“The transition to Version 5010 will have a large impact on information technology staff throughout 2011,” says Kim Reid, CPC, CEMC, CPC-I, and ICD-10 expert for the American Academy of Professional Coders. “The operations of the practice (documentation, coding, and billing) will not feel the effects of ICD-10 until the end of 2011. This is when training on the new system should begin to make it a smooth process.”
ICD-10 change-over websites
ACR
www.rheumatology.org/practice/office/coding/icd10.asp
Centers for Medicare and Medicaid Services
www.cms.gov/ICD10
American Academy of Professional Coders
www.aapc.com/ICD-10
America’s Health Insurance Plans
www.ahip.org/content/default.aspx?docid=31192
World Health Organization
www.who.int/classifications/icd/en/index.html
Centers for Disease Control and Prevention
www.cdc.gov/nchs/icd/icd10cm.htm
Heavy Lifting Ahead
The really heavy lifting for the practice has to be completed by October 1, 2013, the deadline CMS has set for implementation of ICD-10. “ICD-10 is much more invasive to the practice,” says Tennant. “It will impact all areas of the practice starting virtually when the patient first comes in the door. We have never gone through a change before where nearly every physician, nonphysician provider, coder, and even administrative staff must be brought up to speed in a hurry.”
