and 5010 Format
Implementation
ICD-10 Implementation questions should be emailed to the AMBA ICD10 committee at icd10411@ambanet.net
The AMBA ICD-10 Implementation Committee Members are:
Kathy Stull, CPC, CMRS
Jeanette Henderson, CPC, CMRS
Mary Roberti
Barbara Colburn
Kari Behlmer
Lynn Shannon, CPC
Terri Wyman, CPC, CMRS
Cyndee Weston, CMC, CMRS
The AMBA ICD-10 Implementation Committee was created to help members and their providers transition to ICD-10.
In order to accommodate ICD-10, the industry will have to change from using the HIPAA 4010 Format (used now) to the 5010.
What is HIPAA 5010?
Health Insurance Portability and Accountability Act (HIPAA) of 1996 required the Department of Health and Human Services (HHS) to adopt information standards to be used in all HIPAA covered electronic health care transactions.The current standard electronic transaction version is 4010A1; the new updated version is called 5010.
CMS and HHS have mandated the new 5010 standards to be adopted by all healthcare entities by January 01, 2012.
Who will need to upgrade to 5010?
Physicians (all healthcare providers), Billers, Payers and Clearinghouses
What transactions will the 5010 changes impact?
The 5010 version of standards covers all of the following types of standard health care transactions:
837P – Professional Health Care Claims
837I – Institutional Health Care Claims
270/271 – Eligibility for a Health Plan
276/277 – Health Care Claims Status
835 – Health Care Payment and Remittance Advice
For a full list of all transactions and the official HIPAA final rules regarding 5010 please review the
HSS Final Rules and Regulations.***Ask of your vendors (clearinghouses, billing software and payers) where they stand on making their systems HIPAA 5010 compliant to protect your billing company or practice from revenue issues. Demand a timeline of their compliance, testing and certification, as well as their schedule of when they will have your systems ready to submit with 5010 billing transactions.
How can you prepare for the transition to HIPAA 5010?
Because we are in a unique position of having to wait until our vendors are ready, you should begin by contacting your billing software vendor and your clearinghouse to determine when they will be ready and you should continue to follow up with them to ensure timely compliance.
Ask your software vendors: When will they update/upgrade your billing program for testing purposes?
Ask your clearinghouses: When will they be ready for you to test your billing system?
Ask your payers: When will they be ready to allow you to submit 5010 claims?
ICD-10 & 5010 Conversion Timelines
|
Date |
Compliance Step |
| January 1, 2010 | Payers and providers should begin internal testing of HIPAA Version 50120 standards for electronic claims |
| December 31, 2010 | Internal testing of Version 5010 must be complete to achieve Level 1 Version 50 10 compliance |
| January 1, 2011 | Payers
and providers should begin external testing of Version 5010 for
electronic claims CMS begins accepting Version 5010 claims Version 4010 claims continue to be accepted |
| December 31, 2011 | External testing of Version 5010 for electronic claims must be complete to achieve Level II Version 5010 compliance |
| January 1, 2012 | All
electronic claims must use Version 5010 Version 4010 claims are no longer accepted |
| October 1, 2013 | Claims for services
provided on or after this date must use ICD-10 codes for medical
diagnosis and inpatient procedures. CPT codes will continue to be used for outpatient services |
ICD-10 Structural Differences –Diagnoses
•ICD-10-CM has 3 –7 digits
•Digit 1 is alpha (A –Z, not case sensitive)
•Digit 2 is numeric
•Digit 3 is alpha (not case sensitive) or numeric
•Digits 4 –7 are alpha (not case sensitive) or numeric
Number of Diagnosis Codes – as of 2009
ICD-9-CM 14,025