Healthcare providers that use medical billing software to process patient payments must update their programs to comply with ANSI 5010 by the start of next year.
The required updates are related to the industry shift toward the ICD-10 coding set, which must be adopted by all healthcare providers by Oct. 1, 2013. The previous coding set, ICD-9, has been in use since the late 1970s.
ANSI 5010 is the coding system used by healthcare providers to bill Medicare and insurance companies. The transition to ANSI 5010 must be complete by Jan. 1, 2012. Unfortunately, while industry experts recommended providers implement and test the changes during 2011 to prevent billing discrepancies in 2012, few have actually done so.
As of October 2010, the Medical Group Management Association (MGMA) reported to InformationWeek that only 4.5 percent of its member practices had completed their transitions to ANSI 5010.
For that reason, MGMA is recommending that the Centers for Medicare and Medicaid Services (CMS) allow insurance providers to accept claims that are not fully compliant with ANSI 5010 standards for a period of time in 2012.
"The industry is going to survive if some of the codes are incomplete," MGMA government affairs manager Robert Tennant told the news source.
Depending on CMS's decision healthcare providers that fail to act well in advance to conform to the new standard may find that their claims are rejected for not being HIPAA compliant. This would directly affect a provider's bottom line and could lead to unexpected consequences in the future.
Once a healthcare provider believes it has completed the upgrade, it should test the software by sending a claim using ANSI 5010. Even after it receives a successful response from the insurance provider, the hospital or physician should continue to carefully monitor its billing practices. Trusted products from Medisoft and Allscripts can help in this process.