Q&A: A vendor's perspective on HIPAA 5010 and ICD-10

Ana Croxton, vice president of EDI products and services at NextGen

Government Health IT Editor Tom Sullivan spoke recently with Ana Croxton, NextGen Healthcare’s vice president of EDI products and services, about its 5010 efforts and what lies ahead on the road to ICD-10 – including a service that's not yet released but is in the design phase to help users understand ICD-10 codes.

Q: What’s your sense for how prepared health entities are right now for HIPAA 5010?

[See also: ICD-10 is much more than a coding issue]

A: I think they know what they need to do, however, they’re certainly procrastinating. Last week I attended some conferences with AMA and HIMSS, and a lot of payers were there, and that’s pretty widespread. I don’t know what they’re waiting for; it’s not going away. What’s going to happen is there will be a big pileup.

Q: What will NextGen provide its customers in preparation for HIPAA 5010? How does that all work?

A: We follow the same thing we’ve done for other major industry changes, like 4010 and then also NPI, which was another major change very similar in nature to 5010. So we go through a period of internal and external focus groups for preparing and planning. That’s what we’re doing right now with ICD-10. For 5010, we’re full-force. It’s in the current version of our general release of our application. So we do ask clients to upgrade but our clients are not charged for the upgrade. It’s simply a question of getting the inclusion of the changes into the application far enough in advance that clients can plan for their upgrade and generally the rule of thumb is about a year to allow them time to test and then, subsequently, upgrade in their production environment. We’ve done that now with 5010.

And then we go through a series of educational forums that we provide for our clients at no cost. For 5010 it’s a series of white papers, knowledge-based articles, and monthly billing calls focused on 5010 that are primarily affecting the billing operations of an organization. We will increase the frequency as we get closer to the deadline date, knowing that many clients have put off either testing or the upgrade. Right now they’re monthly, in November we’ll go to weekly and possibly more than weekly. That’s when they’re actively engaged in the transition. The value of these conference calls is that, because the nature of the data is transitional, meaning things change as the payers update, adapt, and enforce, actually do their implementation. So there might be slightly different information as things shake out. With ICD-10 there’s a significant change in that you’re not just dealing with the billing people but also with the physician force.

[See also: ICD10 and HIPAA 5010 - Game Changers]

Q: Are you also involved in testing for 5010?