CMS schedules dry run of 5010 electronic readiness

Less than six months before physicians, clearinghouses and insurers must begin using new standards for electronic claims submissions, a government-designated test day will give all sides a chance to gauge their readiness for the switch.

The Centers for Medicare & Medicaid Services has declared June 15 National 5010 Testing Day.

The event is meant to give all "trading partners" -- physicians, clearinghouses, payers and Medicare administrative contractors -- an opportunity to perform a coordinated dry-run claim submission well before the deadline to switch to HIPAA 5010 standards on Jan. 1, 2012.

The new standards, which require physicians to change the way they submit claims electronically, are part of the lead-up to adoption of ICD-10.

For medical offices that use a practice management system vendor to format and submit claims, the changes to their work required under the 5010 standards may be small -- even just a matter of listing a mailing address differently. But experts said it's important for physicians to verify that their vendors are ready for the switch, because incorrectly formatted claims will be rejected beginning Jan. 1, 2012.

The American Medical Association, Medical Group Management Assn. and dozens of others in organized medicine wrote to Health and Human Services Secretary Kathleen Sebelius on Oct. 28, 2010, encouraging the government to institute a "national testing period" for the new standards.

"Moving to Version 5010 will be a very challenging transition for health care providers, especially for smaller practices," the letter said. "Just as the health care industry experienced with the transition to Version 4010 of the electronic transactions and the conversion to the National Provider Identifier (NPI), testing of systems and transmission protocols in advance of a compliance deadline are critical for deterring claims payment disruptions."

The letter suggested the week of June 6-10 because it would leave six months for everyone involved to correct problems identified during the test period.

In its announcement of the testing date, CMS noted that there's nothing to prevent physicians and others from testing before the June 15 date. "Don't wait. You are encouraged to begin working with your [Medicare administrative contractor] now to ensure timely compliance."

More information about the 5010 switch is available online (link).