The Department of Health and Human Services (HHS) is working towards switching from the current set of healthcare EDI transaction standards (ANSI X12 Version 4010) to Version 5010 on October 1, 2011. That switch is partially driven by a need (or strong desire) to switch from ICD-9 to ICD-10 code sets, which are already in use in most of the world.
As promised, the recent announcement of this switch gives providers, insurance carriers, clearinghouses, and vendors 2 years to retool our systems to accommodate the new standards. For most of us, that won't be a huge problem (although we've got a lot of work ahead of us). We'll have to wait and see how well the state payers do...
In any case, it will be interesting to see how these changes ultimately affect AdvancedMD and our customers. Certainly the cost of migration will be significant (more for our customers than for us, I would imagine), but maybe we can hope for some benefits.
For years we've complained about the oxymoronic nature of the term "healthcare standards". The ANSI 837 (claim) and 835 (ERA) transactions were supposed to standardize communication between healthcare providers and insurance companies. In some ways they were successful, but, apparently, some carriers (mostly Medicaids) decided that the standards were inadequate. They ended up finding hundreds of creative ways to violate HIPAA and stick weird data all over the place.
Maybe if we're really, really lucky, Version 5010 will accommodate these carriers' requirements without the need for a bunch of "companion guides". Or maybe the switch to Version 5010 will encourage payers with antiquated adjudication systems to upgrade them so that they can obey the rules.
Hey, it doesn't hurt to hope, right?
Whatever the payers do, we'll soon be embarking on projects to accommodate these new standards so that we can be way ahead of the curve if and when they go into effect in 2011.
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