Issue link: https://viewer.e-digitaledition.com/i/122157
+++++++++++++++++ + +++ + IT UPDATE › +++ +++++++++++++++++ ASC X12 5010 YES, YOU SHOULD CARE By Vance Nelson T HE DEADLINE FOR implementa- tion of ASC X12 Version 5010 electronic transactions was June 30, 2012. Yet, we find it remains a source of confusion among physicians and staff, particularly physicians in private practice. Most electronic transactions that currently f low in and out of your electronic health records (EHR) or practice ma nagement system a re governed by The Accredited Standards Committee (ASC X12), which was set in place by the 1996 Health Insurance Portability and Accountability Act (HIPAA). The current rules for health care transactions are Version 5010, which replaced Version 4010/4010A1. The Version 5010 changes affect covered entities, which include: + Certain health care providers ("certain" as in most) + Health plans + Health care clearinghouses What transactions are covered? Well, some ver y importa nt ones, such as: + Claims (read cash flow!) + Claims status requests and responses (again, read cash flow) + Payment to providers (again, read cash flow) 16 | San Antonio MD NEWS I MDNEWS.COM + Coordination of benefits and premium payments (once again, read cash flow) + Eligibility requests and responses + Referral requests and responses + Enrollment and disenrollment in a health plan If you read the list above, you may have noticed the words "cash flow." I trust you're like me and would like to adopt any change necessary to maintain a positive cash flow. There are two primary reasons Version 5010 changes were necessary. First, many situations could not be anticipated when the older formats were put in place. As a result, payers and other organizations were using the old standards to "force-fit" situations that weren't handled well. I can tell you, as head of a software company that deals with these transactions frequently, we and vendors like us have many times taken on the burden of handling force-fit situations to make sure our clients don't suffer because of them, particularly when it comes to cash flow. The new format will handle more of these situations in a more standard way. Secondly, Version 5010 creates the foundation and paves the way for ICD-10, which will go into effect in 2014. The previous formats simply could not handle the ICD-10 changes. A Word to the Wise Just because your transactions are currently working and you are getting paid for insurance claims doesn't necessarily mean you're out of the woods. Most clearinghouses currently "up-convert" an older format to the new format; however, they are not mandated to perform this step, so they can stop at any time. Action Point Take action now and ensure your software solution, particularly software dealing with insurance claims and eligibility, can directly produce Version 5010 transactions without relying on an up-convert process. Contact your software vendor if you're not sure, and if your current software has these limitations, at least ensure the vendor details an upgrade path for the near future. Vance Nelson is President/CEO of HealthTec Software, Inc. He has held business and technical management roles in health care software development for more than 20 years. HealthTec Software is located in San Antonio and serves clients nationwide. Since 1999, HealthTec has created powerful, easy-to-use software for a wide variety of practice sizes and specialties. The company's latest offering, HealthTec Trilogy, is a fully certified EHR that blends clinical and financial functionality into an easy-to-use product that adapts to the practice. For more information, call HealthTec Sof t ware at (210) 545-1010, or visit www.httrilogy.com. I