Raul Villar, president, ADP AdvancedMD

With the ANSI 5010 deadline (to avoid penalties) extended to March 31, 2012, members of the healthcare industry have been trying to define “ready” as it relates to implementing ANSI 5010 standards.

There are dozens of different levels of readiness at this time.  Some carriers were able to start years ago rebuilding and rewriting their programming code – front to back – to prepare for 5010 and ICD-10.  Others, such as California Medicaid, are not able to predict a date when they will be ready to send or receive a 5010 transaction.

Transition is proving to be a challenge especially for medical practices on traditional client-server or application service provider (ASP) technologies that face on-site upgrades to achieve compliance. Many organizations, where the software is legacy, client-server managed at each client or office site, are struggling to keep up with fixes needed to address the errors that arise during testing.  Just because a software has met the definition of “ready,” being able to send and receive data in the 5010 format, does not mean all their clients are able to – in many cases it takes a minimum of 6-8 weeks to schedule software updates at clients’ sites and to implement small changes across their client base.

ADP AdvancedMD has studied this and other regulatory updates that pose such an overwhelming obstacle especially to small practices. This is one of the reasons ADP AdvancedMD chose to deliver practice management, billing and Electronic Healthcare Record solutions through a cloud-based approach. With this type of technology, physician practices are able to move forward with compliance without an IT staff, exploit the features needed for them to efficiently deliver service to patients, and realize better ROI on claims to secure the bottom line.

What ADP AdvancedMD recommends to all practices going through the ANSI 5010 transition is:

  1. Double-check the data in your master files with your top payers, ensuring the data (NPI, Tax ID or Social Security Number, Address, etc.) entered matches the data your payers have registered in their systems.
  2. Take advantage of sending production files with any 5010-compatible software, such as ADP AdvancedMD’s 2011 Fall release.  For ADP AdvancedMD clients, that means that before the deadline, they can transmit a day’s worth of claims through our 5010 enhanced claims process and change back to sending 4010 while you work though any edits and/or rejections, so customers can maintain cash flow and ensure that any kinks with payers’ and providers’ specific data are worked out before the 3/31/2012 deadline.
  3. Make sure to use resources at your billing provider or EHR provider- they should be able to help you through the process. For instance, our client Nancy Ward, practice manager for family practice physician John M. Ward, D.O. received coaching while testing the new ANSI 5010 transactions. ADP AdvancedMD advised her to enter the full 9-digit zip code and change some legacy provider information to avoid any mishaps. It is these little details, which if ignored, could result in a claim rejection.

At ADP AdvancedMD, we released ANSI 5010 compatibility to our clients in fall, 2011, making for an easier transition for physician practices as well as billers. We have strongly urged our clients to test and implement transmission of 5010 files as soon as possible, despite the extended deadline. We look at this deadline push of 90 days as a time for practices to work through any edits with payers. As MGMA data has shown, denied claims often result in revenue that’s never recaptured – so reducing denials early is critical to optimizing revenues during the transition. Being ANSI 5010 ready now, ahead of the curve, enables practices to be prepared for the upcoming regulatory format change and avoid the risk of increased denied claims not only for ANSI 5010, but also in preparation for the next wave  – ICD-10.

About the Author

Raul Villar is president of ADP AdvancedMD, a leader in all-in-one, cloud electronic health record (EHR), practice managementmedical scheduling software, and billing applications for medical practices and medical billing services. A 22-year veteran of ADP, Villar has held numerous senior level positions, most recently as ADP’s Senior Vice President of Major Account Sales, an organization that provides HR, benefits and payroll services to mid-sized organizations. In this role he led a team of 1,500 associates who deliver $300 million in annual new business sales.