With a federally imposed deadline looming, most office-based physician practices have yet to receive updates to their financial systems software that will allow them to convert to ASC X12 Version 5010 data-transmission standards, according to the Medical Group Management Association.
Most doc practices not ready for 5010: MGMA
The federal compliance deadline for switching from the current Version 4010 standards to 5010 is Jan. 1, 2012. Based on industry guidelines, practices and hospitals should have had the upgrades installed and started testing them with their external business partners by Jan. 1 of this year.
The MGMA survey provides another glimpse at mounting evidence that the industry is falling behind not only on 5010 but also on progress toward switching to ICD-10 procedure and diagnosis codes—and the federal deadline for that transition is Oct. 1, 2013. Converting to 5010 standards is a necessary precursor to moving to ICD-10 codes.
According to MGMA’s research, just 8% of practices in the survey have done internal 5010 testing. More than half (56%) of practices have yet to even schedule internal testing, according to the survey. Guidelines on 5010 conversion suggest that internal testing should have been completed last year and providers in 2011 should be evaluating the flow of transactions between themselves and their trading partners, including health plans and claims clearinghouses. Only about 5% are doing this external testing, according to the MGMA survey.
Only 16% of practices surveyed indicated they were "extremely confident" they would be ready by the 5010 deadline. About one-third (34%) said they were "confident"; 23% said they were "somewhat confident"; 11% said they were "slightly confident"; and 15% said they were "not confident." (Rounding and "not applicable" accounted for the remaining 1%.)
"What we’re trying to do is raise awareness in our membership and maybe light a fire under some of the vendors to reach out to our guys," said Robert Tennant, senior policy adviser to the MGMA. "What you need to know is if you vendor does not intend to update, you need time to pick a new system. It's not something you want to do at the last minute in December."
The 5010 mandate stems from a 2009 update to the Health Insurance Portability and Accountability Act, but whereas practices, insurance companies and claims clearinghouses are required to comply with HIPAA provisions, vendors are not. According to Tennant, vendors may be focused on the opportunity to sell electronic health-record systems to physicians in time for them to install and meaningfully use these systems to be eligible to receive Medicare and Medicaid incentive payments under the American Recovery and Reinvestment Act of 2009.
"The only one not mandated to do this (5010 conversion) is the vendor," Tennant said. "This upgrade will be part of their maintenance contract, so there is no new money for the vendor." Tennant said MGMA plans to conduct a follow-up survey in late summer and early fall. "Hopefully, we'll see some change in the numbers."
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