Healthcare providers in 2011 should be busy preparing for the implementation of the 5010 transaction set. This HIPAA transaction requirement is scheduled to become effective Jan. 1, 2012, representing the language that allows payer claim systems to receive and understand what is reported on provider claims. 5010 includes more than 850 changes from the current transaction set (4010) and offers new features such as coordination of benefits, font specification, privacy options and eligibility verification, among many others. However, the tie between 5010 and ICD-10 is that 5010 will allow for the new attributes of the ICD-10 code, specifically its length and alpha-numeric structure.
5010 Transaction Set
Starting Jan. 1, 2012, providers will submit transactions and payers will receive them through the use of the 5010 transaction set. Until then, we will find our patient financial services and IT staffs wrapped up in the upgrade to 5010, testing transactions with predominant payers and addressing any deficiencies during the testing stages. But soon after the effective date, if it’s not a process already is in progress, our IT teams will need to direct their attention to preparing for the implementation of ICD-10.
In a collaborative effort, IT and HIM should be leading ICD-10 preparation for healthcare providers. The first stage should include education, starting with senior leadership, and naming a senior leader to serve as program champion. The education stage also must include delivering general education to middle management. The entire organization needs to understand how ICD-10 will add to the richness of coding data and the anticipated impact this classification change will have on the organization’s fiscal health.
The second stage will require participation from most middle managers in identifying any application, system and report that captures, stores, distributes or displays an ICD-9 code, diagnosis or procedure today. Additionally, these middle managers will need to provide vendors with contact information or contact the vendors to determine their plans for ICD-10. This inventorying effort will serve as the basis of an investigation and analysis of those steps required to prepare for ICD-10, including modifying reports, updating applications, installing upgrades and replacing systems or applications. Obviously, an IT work plan must be created based on the initial inventorying and evaluation efforts.
The next stage goes beyond technology and involves penetrating work processes with an assessment of those functions that use or create ICD-9 codes today – such as registration staff in their querying a medical necessity application, or a scheduling nurse utilizing a payer eligibility system to secure an authorization for a procedure or inpatient admission. Questions that will need to be posed include: Will registrars and schedulers require coding education? Will HIM coding professionals be added to these functions? Once analyzed, will the workflow change? Will these functions be transferred to HIM responsibility?
The fourth stage involves planning for the changes to management analytics. Will reports need to be modified? How will reports generated with ICD-10 codes be compared to historical reports with ICD-9 codes? Are there edits in the information system that are designed to ensure that accurate ICD-9 codes have been entered and require modification?
There are several stages we have not covered here, however one of the last involves preparing individuals in the organization to use this new classification system. Often leadership automatically will think of the coding professionals in the health information management department, but there are others who need to be considered. The educational processes will differ depending on the requisite skills required for the job being performed. Additionally, when the education should occur will vary. We will discuss the stages cited in this article and other stages in further detail in upcoming articles.