| HOSPITALS: Get 5010 Ready |
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The new HIPAA 5010 versions of the x12 transactions provide greater granularity of payer data, a significant improvement over the current versions. This added clarity can enhance your ability to manage denials and rejections and optimize reimbursement. But it’s a complex transition that will affect the staff, revenue cycle processes, and technology infrastructure of a hospital. To receive accurate and timely reimbursement, hospitals need to start testing now.
Business Issues
Hospitals may experience challenges during and after the transition to 5010 including:
- Older EDI and billing technology systems must be assessed to determine their 5010 transaction capabilities and upgraded as appropriate
- Clauses in contracts with claims clearinghouses and vendors must be reviewed to make sure that they require them to maintain software compliance
- Operating budgets have already been established but may need to be increased to cover the cost of transition
- Staff resources need to be allocated to create transition task force and action plan
- Vendor readiness and cooperation may be major hurdle
- Direct connections with trading partners must be coordinated and managed throughout the transition
- All transactions must be tested for 5010 compliance and interoperability prior to deadline and testing with payers and other trading partners begins in January 2011
- The ability to perform in-stream validation to remove invalid claims will need to be in place to minimize reduction in denials
- Compliant, direct-connect transaction portals must be deployed in advance of deadline
- Upstream legacy systems such as patient management and accounting will be affected
Critical questions every executive should be asking:
- How do I perform an inventory of existing systems to determine which will be affected by the change?
- What are my vendors’ upgrade plans?
- Will my business partners and clearinghouses be ready by the deadline?
- When do I need to conduct a gap analysis to identify 4010A1-to-5010 gaps?
- Where do I start in developing a migration plan?
- How can I identify active beta testing partners through our clearinghouse and product users?
- How do I establish a testing methodology that is comprehensive, manageable, and effective?
- Will my billing service or clearinghouse increase their fees for the 5010 transactions?
- When can I send test transactions to my billing service or clearinghouse to make sure the system will work?
- Can I bypass clearinghouses and associated fees, and move to direct connections?
- Will I need to re-negotiate my provider contract or EDI agreement based on 5010 transactions?
- How can I plan ahead for changes in work flow and staff training to minimize disruption?
- What is the cost of training resources?
- How do I know which transactions to test and will we conduct the testing with test data or live production data?
Why should you consider Ingenix as a 5010 partner?
Our comprehensive solutions can help your organization use the 5010 transition as a springboard to improved operating effectiveness:
- Ingenix Claredi® Classic—HIPAA 5010 and 4010A1 preproduction transaction testing and certification
- Ingenix Faciledi®—In-stream validation and routing of HIPAA x12 5010 and 4010A1 production transactions
- TransactionManager™—Direct EDI connection management system for providers and hospitals
- Transaction Exchange—National health care clearinghouse
- Ingenix Learning and Development Services—Online or onsite classes to educate functional and technical staff on HIPAA 5010
- Consulting Services—Wide-ranging expertise to help organizations assess, plan, and implement HIPAA 5010, ICD-10, and other solutions
GET STARTED NOW.
Contact Ingenix to discuss your 5010 preparation.
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