ANSI 5010 and ICD-10 Are Coming. Preparation Begins With Reliable Information.

 

The healthcare industry is switching from an ICD-9 code to the new and more inclusive ICD-10. The Centers for Medicare and Medicaid (CMS) and others in the HIT industry recognize the necessity of transitioning, sooner rather than later, to a new standard for claims transactions-version 5010 of the ANSI X12, (better known as ANSI 5010).

 

The urgency is easily overlooked because the required date for implementing the ANSI 5010 claim submission format is January 1, 2012. ICD-10 is October 2013. The challenge is to not let those dates give you a false sense that there is no urgency.

 

There are always unforeseen problems implementing changes of any size across a body of users as large as we have in the medical community. The magnitude of these changes (ANSI 5010 and ICD-10) exceeds anything we've seen in recent years. The associated risks are at least proportionally higher.

 

What is the first step for any organization that will be affected by the new standards? Gather information.

 

1. Review and categorize the information.
2. Analyze your needs in light of what you learn.
3. Make a preliminary plan based on your analysis.
4. Put the plan in writing along with assumptions you make to justify and test the plan.

 

At this stage you may determine that no action is required. If that is the case your next step is to continue gathering information and schedule another round of analysis and plan review in one to three months. Given the time frames associated with these new standards, waiting longer than 3 months will dramatically increase the risk of non-compliance to your clinic.

 

Many software vendors and service providers such as clearing houses have made or are now making changes to their systems and services to accommodate the new standards. They are putting themselves in position to have a full year or more for live testing of their changes. And they expect to make some, perhaps many, changes before the go-live dates.

 

This author is suggesting that clinics and other users of the software and services take the same tactic. Engage the new standards as early as practical for your organization. If that means getting new software-get new software. If it means changing to a different service provider-make the change. Invest your time and energy in learning and working with the new standards. They are not going away.

 

You too will be required to make changes. At a minimum you will need to change some office procedures. You will need to train existing staff. New procedures and training always take more time than expected.

 

There is no need to wait until changing to ANSI 5010 for claims filing and ICD-10 coding requirements become urgent. Urgency tends to create unnecessary crises. Crises lead to mistakes. All of the above translate to higher costs and lost revenue.

 

Act now with an eye toward the future.