As 5010 Testing Week Approaches, PCC Contends with Lack of Payer Readiness

As the federal government gears up to boost its effort to prepare providers and trading partners for the transition to Version 5010 of the HIPAA electronic transaction standards, Physician's Computer Company continues to wait for the majority of its payers and clearinghouse partners to comply.

In March, we reported that PCC and two of its Pennsylvania-based payers were in full production mode with the HIPAA 5010. Now, five months later, PCC has picked up a few more payers that are “production-ready,” but the majority have yet to complete the kind of testing necessary to meet the Jan. 1, 2012 compliance deadline.

And while the direct-to-payer connections PCC has made so far affirms that its Partner practice management system and centralized Electronic Data Interchange (EDI) hub are fully capable of sending and receiving the updated claims form, PCC's EDI team wants to avoid a glut of last-minute transitions.

“For us, it's a lot like flicking a switch, but there's a lot riding on that switch,” said Justin Ballou, PCC's EDI Team leader. “We'd prefer a controlled, stepped migration for any given connection. The closer we get to Jan. 1, the less likely we can do that properly.”

Non-compliance with 5010, the Medical Group Management Association (MGMA) has warned, could lead to rejection of claims processing and other practice administrative processes.

To step up preparedness efforts, the Centers for Medicare and Medicaid Services (CMS) will launch National 5010 Testing Week, starting Aug. 22. As part of the program, CMS has planned to offer a “real-time help desk,” and Medicare administrative contractors will be ready to provide assistance.

The MGMA, whose recent survey shows that while most practices know about the 5010 mandate, few are ready to make the transition, is calling for CMS to work on a contingency plan for HIPAA 5010 that focuses on allowing health plans to accept claims that do not contain all required 5010 content.

It is the 5010 transition, which, in part, prompted the MGMA and American Medical Association (AMA) to offer a Practice Management System Toolkit. The online resource evaluates the capabilities of various practice management systems, including PCC's. Among the details listed for each system is information related to 5010-readiness.

A practice that might be shopping for a practice management system, or an existing client who wants to review Partner's 5010 readiness might benefit from the toolkit, PCC's Ballou suggested. “If someone wanted to see our 5010 readiness as it compares to other vendors, it shows we're very much in the game.”