5010 the Kareo Way

Despite major changes in the healthcare industry, we continue our pledge to be the most user-friendly, easy-to-buy, and easy-to-setup medical billing solution for your practice – even with the 5010 transition and the not-too-distant ICD-10 change.

What is 5010 and what impact will it have?

Prior to 2012, medical claims had a fairly universal format – called 4010 – which organizes patient information, diagnoses, procedures, and several other categories of information so it can easily be sent electronically between medical practices and insurers. Due to changes that will be coming in 2013 with ICD-10, there are modifications necessary in the 4010 format. The 5010 transaction set is simply the new, updated format that will pave the way for the ICD-10 transition. For some payers, use of the new format actually began prior to January, 2012. And, since the New Year, all physicians and HIPAA covered entities are required to make efforts to use the new format. CMS has delayed any enforcement of 5010 non-compliance until April, 2012.

What can current Kareo customers expect during the 5010 transition?

The majority of the new 5010 data elements are already contained within Kareo. Most of the changes are within the actual claim format and are not readily visible to those using Kareo. For a side-by-side review of the new 5010 structure compared to the 4010 format, access the comparison documents located on the CMS website.

What’s happening behind the scenes at Kareo to prepare for 5010?

In preparation for the January 1^st deadline, Kareo has deployed changes required for medical practices to transmit claims with the new 5010 format. It is possible that some minor refinements may be necessary between now and the new CMS enforcement deadline as more and more insurers and clearinghouses begin working with the new formats. The Kareo team is carefully monitoring the electronic data exchanges and will update the Kareo customer family routinely.

What role will claims clearinghouses play in 5010 achievement?

The success of the 5010 transition not only requires adjustments within the medical practice, software services like Kareo, and payers, but also accommodation by the claims clearinghouses to transmit the claim files to/from the payers. Kareo customers use either Gateway EDI or Capario. Extensive testing of the 5010 exchange will be conducted between Kareo and both of these leading clearinghouse companies – eliminating the need for Kareo customers to directly test with each payer. Furthermore, the Kareo clearinghouse partners are well underway with their testing efforts and have validated their readiness for 5010.

What do Kareo customers need to do and when?

Kareo is committed to making medical billing as easy as possible. Unlike traditional medical billing software, Kareo’s advanced cloud-based technology allows for rapid updates to comply with industry changes – like 5010 – with little or no impact on the customer experience. Most of the changes will take place behind the scenes. However, there are a few things Kareo customers should ensure the items below have been updated in their Kareo accounts.

• Update 5 digit zip codes to the full 9 digit zip codes.
• Add physical addresses to replace PO Boxes.
• Enter a new “Pay to Address” if you currently receive payments at a PO Box or a lockbox.

Please review the Kareo 5010 Compliance Checklist for detailed instructions and the Getting Ready for 5010 blog post for training videos on how to make updates to the three areas mentioned above.

Routine customer communications will keep the Kareo family up-to-date with our 5010 progress. More importantly, Kareo encourages customers to ensure they are thinking ahead to the bigger ICD-10 transition by October 1, 2013.

Where can I learn more about 5010?

There is no shortage of 5010 resources! But, we’ve consolidated several for you through the following resources:

• Latest Kareo 5010 Blog - “New Release: Introducing the Information Panel and More 5010 Readiness Updates”
• Kareo Blog - “Getting Ready for 5010 – Settings You Should Know”
• Kareo Customer Newsletter – “Will Kareo Customers Be Ready for 5010? Of Course!”
• Getting Paid blog – “ICD-10 Training Camp: Ready, Set, Go – to 5010”
• Getting Paid blog – “…Preparing a Blueprint for ICD-10/5010 Success”
• Getting Paid blog – “ICD-10 Training Camp: How to Survive the ICD-10/5010 Transition”
• Recorded Webinar – “How to Prepare for ICD-10/5010 to Reduce F41.1 (Anxiety Reaction)”
• Recorded Webinar – “Preparing for ICD-10-CM: The Nitty-Gritty of Diagnosis Coding”

Please note that this update to Kareo software will be provided at no charge, as are all of our updates. If you have additional questions, please feel free to contact us at Support@Kareo.com, via the Comments section of this blog, or on our Facebook page.