HIPAA 5010 & ICD-10 Readiness
The HIPAA 5010 specifications are replacing the HIPAA 4010 specifications, as of January 1, 2012 only 5010 transactions will be accepted for electronic claims, remittance advice, claim status, and eligibility.
On October 1, 2013 ICD-10 codes will be required instead of ICD-9 codes for diagnoses.
WinCare will be updated with the required changes prior to the effective dates.
Q: Tell me more about the 5010 changes?
A:
The 5010 changes have to do with the format of transmission files used in electronic Health Care Claims, Remittance Advice, Claim Status Requests, and Eligibility Inquiry. The Integrated Financial version of WinCare uses the 4010 format to create 837 Institutional Claims and to import 835 Electronic Remittance Advice files to apply the payments. WinCare will convert both these features to use the 5010 format. WinCare began testing the 837 Institutional claims in June 2011 with Noridian TotalOnboarding and Trailblazer. WinCare users will be able to begin 5010 testing in September 2011.
Medicare and some of the other fiscal intermediaries will be returning a 5010 277CA (claim acknowledgement) file, support for this file format is not required and will not be provided in WinCare. Clients will need a third party 5010 277CA viewer to determine if their claims have been accepted or rejected, and if rejected, Why?
Since the clinical version of WinCare doesn't support electronic transactions, users will not see any changes.
Integrated Financial WinCare users will see new setup screens for the 5010 837 claims, as well as an option in the EDI module to select the 4010 or 5010 version for the transmission file. The WinCare program has the ability to create either format.
WinCare has been attending and will continue to attend CMS 5010 National calls to stay current with the conversion.
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Q: Tell me more about the ICD-10 changes?
A:
Claims for services provided on or after October 1, 2013 must use ICD-10 codes for medical diagnosis. ICD-9 diagnoses will only be accepted on clams with service dates prior to 10/1/2013. WinCare is planning on adding a section to the resident face sheet for the entry of ICD-10 codes well ahead of the effective date so facilities will have adequate time to have both ICD-9 and ICD-10 diagnoses for their residents.
In the May 2011 CMS ICD-10 National Provider Teleconference, CMS said they expect to be releasing some guidance for facilities, on whether they can convert ICD-9 codes to ICD-10s, or if they need to have the physician provide the new codes.
If they do allow automatic conversion from ICD-9 codes to ICD-10 , for codes with a one-to-one mapping, WinCare will automatically do the conversion. And for codes with one-to-many (One ICD-9 code could map to multiple ICD-10 codes), WinCare will offer the users the ICD-10 choices for each ICD-9 and the user can select the appropriate code. Only active ICD-9 diagnoses will need to be converted to ICD-10 for the MDS and claims. We are expecting that when a new ICD-9 code is entered in WinCare for a resident that the program will suggest or ask for the ICD-10 code at the same time.
At this time the ICD-10 effective date is two years away, so the information presented here is subject to change. Our goal is to have the ICD-10 update available for download by 7/1/2013. The projected version will be 8.0 or 9.0. The ICD-10 update will be for both the Clinical-Only and Integrated Financial versions of WinCare.
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