Cloud-based offerings like new ADP Advanced MD can ease healthcare providers transitioning to new electronic data format standard for claims transactions.

Marianne Kolbasuk McGee, Senior Writer, InformationWeek

November 15, 2011

4 Min Read

Beginning in January, healthcare providers will need to submit to payers claim transactions that comply with the new ANSI-5010 data format. Some healthcare providers are using cloud based services to get a head start in compliance now.

ADP Advanced MD announced availability of a new fall 2011 release of its e-health record, practice management, scheduling, and billing software, which are ANSI-5010 ready. That enables healthcare providers using the new software to immediately send ANSI-5010 formatted transactions to payers that are also already conforming to the new standard.

In addition to ADP Advanced MD, a number of other healthcare software vendors in recent weeks, including 3M Health Information Systems, have been unveiling new versions of products to help doctors and hospitals comply with the upcoming standards, also known as HIPAA 5010.

Because the ADP Advanced MD is a cloud based offering, customers can take advantage of the software's 5010 compliance with minimal or no disruption to workflow before the January 1, 2012 deadline, said Steven Zobell, ADP Advanced MD VP of product development.

"We built the systems to watch for rejections" of claim, said Zobell who estimates that about 60% of payers are currently able to accept 5010-compliant claims.

Typically, users of various on-site, client-server, or homegrown software packages need to purchase and install upgrades or make their own coding conversions to be compliant with ANSI 5010.

"Our goal is to make it easy for users to meet the Jan. 1st deadline," Zobell said in an interview with InformationWeek Healthcare.

So far, for some beta users of the new ADP Advanced MD 2011 Fall Release, the transition to 5010 has indeed been painless.

"The move to 5010 has been pretty transparent for us," said Nancy Ward, practice manager and wife of solo-practitioner Dr. John Ward, a family practice physician in Missouri. An early "glitch" in sending 5010 compliant claims to a payer that wasn't ready for the new standard has since been fixed, she said.

The practice prefers using cloud-based services for billing in large part because software updates like the 5010 conversion doesn't require technical expertise from the doctor's office four-person staff, said Ward.

In fact, even though Dr. Ward's practice is ready early for the 5010 conversion deadline, his office won't be trading in its paper patient records for e-medical records. The doctor, who is in his "late 60s but has no plans to retire" in the near term ikely won't be participating in the HITECH Act's financial stimulus programs for the meaningful use of e-health records.

"Even with the financial incentives, we're not interested" said practice manager Ward.

Meanwhile, as for the transition to 5010, the move means several required changes in claims transactions by healthcare providers. Among the changes in ANSI 5010 are the use of nine-digit zip codes and the elimination of post office box addresses for billing in favor of physical mailing addresses.

Those and other changes are reflected in the ADP Advanced MD 2011 Fall Release without any additional work by healthcare providers, said Zobell.

The move to ANSI 5010 is a prerequisite for an even more complex conversion also on the horizon for healthcare providers—the transition to ICD-10 format for clinical diagnosis and procedure coding. ICD-10 compliance will be required for medical billing transaction beginning in Oct. 2013.

Once the transition to the current ICD-9 to the new ICD-10 becomes effective, the number of clinical codes for billing claims will grow from about 18,000 today to 140,000 codes in late 2013.

Some healthcare providers groups, including organizations such as the Medical Group Management Assoc. and the Health Information and Management Systems Society have asked the federal government to develop a contingency plan that would allow insurers to pay claims that don't meet the new 5010 format after the Jan. 1 2012 deadline.

Members of those groups, as well as some other healthcare organizations, have contended that between ANSI 5010, upcoming ICD-10 transition, and the approaching HITECH Act meaningful use compliance deadlines, healthcare providers have too many IT-related mandates on their plates.

In fact, just this week, the AMA House of Delegates voted to try to stop the implementation of ICD-10.

The new InformationWeek Healthcare supplement explains how the most astute healthcare providers are putting those billions of dollars in federal stimulus funds to productive use. Download the supplement now. (Free registration required.)

About the Author(s)

Marianne Kolbasuk McGee

Senior Writer, InformationWeek

Marianne Kolbasuk McGee is a former editor for InformationWeek.

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