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TAOG Executive Office Karen O'Briant 141 Idlewild Creek Road Sweetwater, Texas 79556 (325) 235-1959 FAX: (325) 235-4687 TOLL FREE (866) 935-1959 TAOG 
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| (9-12-11) WILL INSURORS STOP PAYING YOU JANUARY 1?? |
You are here: Home > (9-12-11) WILL INSURORS STOP PAYING YOU JANUARY 1??
Texas Medical Association
SPECIAL ISSUE: Insurers Will Stop Paying You Jan. 1
That doomsday headline will come true if you do not upgrade your electronic billing systems to comply with the HIPAA 5010 electronic claims standards. If you don't do so by Jan. 1, 2012, Medicare, Medicaid, and the commercial insurance carriers will not pay your claims.
The U.S. Department of Health and Human Services requires all "covered entities" (physicians, clearinghouses, insurers, and others with access to digital personal health care data) to convert to the new 5010 transaction set by Jan. 1. These are the electronic transactions used to transmit patient, physician, and provider data among those covered entities.
Despite what you may have heard elsewhere, the Centers for Medicare & Medicaid Services (CMS) will not delay the deadline. It will remain Jan. 1.
TMA will conduct a Tele-Town Hall Meeting on the electronic claims standards at 8 pm on Thursday, Sept. 22. TMA President C. Bruce Malone, MD, will moderate the discussion, which will feature expert presentations from TMA physician leaders and staff. Dr. Malone will call you at your home telephone number and invite you to stay on the line to learn about HIPAA 5010.
By participating in the call, you will learn the details of the conversion, how to prepare to upgrade your practice management or electronic health record (EHR) system, how to develop an action plan, and the impact on your business functions.
If you want your office administrator to participate in the call or if you prefer that we call you on your cell or office telephone, contact the TMA Knowledge Center by telephone at (800) 880-7955 or by e-mail to:
knowledge@texmed.org by Tuesday, Sept. 20.
TMA has established the TMA HIPAA 5010 Resource Center on the TMA website (http://www.texmed.org/5010/)
to help you make the conversion. It includes background information on the issue; questions to ask vendors; contact information for EHR, practice management, and clearinghouse vendors; information on how you can finance upgrades to your existing system or purchase a new system; and an action plan.
Please go to the following website to answer these questions to let TMA know what progress you have made in updating your billing systems to meet the Jan. 1, 2012, deadline.
https://texmed.qualtrics.com/SE/?SID=SV_8wCKrV052DIT07a&Preview=Survey&BrandID=texmed
TMA will publish the results and information about 5010-ready vendors in the 5010 Resource Center as information is returned.
The switch from Version 4010/4010A1 to Version 5010 is part of the ICD-10 conversion that takes effect Oct. 1, 2013. It involves updated codes and transactions standards that will cover improvements to electronic claims, insurance eligibility verification, claim status inquiries, requests for authorizations, and electronic remittance data. Unlike Version 4010, Version 5010 accommodates the ICD-10 code structure. The changeover will require equipment upgrades and comprehensive staff training.
ICD-10 will fundamentally change the way you practice medicine.
ICD-9 has only some 14,000 codes, while ICD-10 has more than 68,000 codes. In some instances, the number of potential codes that could be used for the same diagnosis has increased exponentially. For example, CMS says there are nine potential location codes for pressure ulcers under ICD-9-CM, while ICD-10-CM has some 125 codes. The ICD-9 codes show broad location but not depth, whereas the ICD-10 codes show specific location as well as depth.
TMA is planning hands-on workshops and training for physicians and staff in early 2012 to help physicians switch from ICD-9 to ICD-10. Check the TMA website for updates. TMA currently offers a variety of training options, including webinars and ICD-10 "boot camps".