The Centers for Medicare & Medicaid Services (CMS) has issued a fact sheet on Version 5010 transaction standards to assist with a smooth transition.
CMS outlined steps providers can take to maintain continuity of operations for their practices as they prepare to complete 5010 testing and implementation:
- Have a transition plan in place: The plan should document the steps that will be followed and the dates that milestones will be achieved to comply with Version 5010 requirements. Make the plan available to payors and other business partners so that testing can be scheduled.
- Communicate regularly with vendors; encourage them to take action to avoid problems with reimbursement: Providers should identify areas within their practice that depend on vendor support and communicate with their vendors immediately to ensure their systems will be up-to-date. "Hold vendors accountable by discussing business requirements to ensure products are Version 5010 compliant," CMS stated. "Ask vendors about the new Version 5010 features and request trainings to make sure internal staff is comfortable using the updated system. Lastly, talk to vendors about any contract upgrades or costs involved with implementing the new software."
- Reach out to a clearinghouse for assistance: A clearinghouse ensures that claims smoothly transition between practices and payors. When providers submit noncompliant claims, the clearinghouse translates the claims into a compliant format and sends the compliant transactions to payors.
- Establish a line of credit: Providers should work with their financial team to establish or increase a line of credit to cover potential cash flow disruptions, CMS stated. "A line of credit will help a provider’s practice prepare for potential delays and denials in payor claims reimbursements due to noncompliant Version 5010 transactions being submitted. A practice should also evaluate its cash reserves."
CMS stated that additional resources are available on its website.