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ANSI 5010: Are You Blowing Off the Deadline?

by Jenn Marshall, Director of Transaction Services

People who don’t regularly find themselves in houses of worship will often turn to prayer when facing dire circumstances like, say, jungle combat or the inside of a jail cell.

Now a recent article in Modern Healthcare references a study by KLAS on preparation among medical providers for the looming January 1 conversion to ANSI 5010—and it turns out some of those providers have lately found religion.

The KLAS survey of 800 office-based providers found not only that a majority has not bothered to prepare but that providers are putting their faith in claims clearinghouses to do all the work required for the transition. The report found what a substance abuse counselor might describe as instances of “denial” among caregivers.

According to one such provider quoted in the piece, “I'm honestly trying to pretend that 5010 changes are not going to occur… I pray that (our clearinghouse) will be able to deal with the changes. Because of what they are telling me, I think they will. I hope they have been telling me the truth.”

It’s not like ANSI 5010 should be a surprise. The Centers for Medicare & Medicaid (CMS) have been diligent about waving the warning flags. Just last week, the agency released a notice that “The compliance deadline for the transition to Version 5010 is only two weeks away!” It was accompanied by a reminder that there’s now an “enforcement discretionary period” out to April 1, as well as links to updated fact sheets, webpages and other resources.

And then on Dec. 19, the Medical Group Management Association (MGMA) acknowledged all this and asked for a six-month contingency plan so that medical practices are not negatively impacted in early 2012. They used some strong language backed up with hard facts.

So what’s the point?

If you’re an athenahealth client, a lot of this is irrelevant because we’ve got you covered. You may recall a blog post from October about how “… thanks to our cloud-based model, 100% of our clients are already using a 5010-compliant version of our practice management services that we updated at no additional cost.”

So since the praying contingent among our clients can reserve their spiritual energies for causes other than ANSI 5010, we thought now might be a good time to share some fun facts we’ve gathered in the course of our work on the transition.

 For our top 100 payers:

  • Only 32% of our claim volume was available for 5010 conversion prior to Q4, due to lagging payer and vendor timelines. Despite this delay, we’re now at over 60% 5010 claim submission and expect to close the year above 85%.
  • Production testing is available for 73% of this volume. This is the gold standard of testing—sending real claims for real adjudication before flipping all volume live. By sending small volumes of production 5010 claims before converting it all, we’ve found and resolved production issues with many payers prior to go-live. This spares our providers literally tens of thousands of claim rejections and denials.
  • While the CMS grace period protects providers from being fined for non-compliance, we think that a lack of payment in 2012 would be an even more distressing financial penalty.  Many payers (Medicare included) will not accept 4010 claims after December 31, 2011, so timely conversion is critical.

There it is. We are ready. Our clients are ready. And if you’re a physician who lives in a state of denial about ANSI 5010, maybe it’s time you talk to someone instead. In the meantime, check out this on-demand webinar about ANSI 5010 and this recent ICD-10 webinar. Just know you are not alone and it doesn’t have to be so bad.

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