Most HIPAA 5010 and ICD-10 coverage focuses on how far behind payers, providers and vendors are in the conversion. Less often discussed is the role being played by vendors that are that are up-to-date.

For HIPPA 5010 at least, NextGen Healthcare has issued the necessary software upgrades and is working with customers on internal and external testing.

Government Health IT Editor Tom Sullivan spoke with Ana Croxton, NextGen’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?
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.

[Cover story: ICD-10's ten-year reign of fear.]

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.

Q: Are you also involved in testing for 5010?
A: Absolutely, we work our partner clearinghouses and have joint WebEx’s with, say, Navicure to say, "This is what customers need to do in the application to meet the requirements’ and ‘this is how this particular clearinghouse will handle it." Maybe you’ll send 5010 to all payers and those that are not ready will handle it. Maybe they’ll want two separate files; it depends on the clearinghouse. But we do joint communications with each of our partner clearinghouses.

Q: One of your customers told me the ICD-10 updates would come in version 5.8, when can customers expect that?
A: They should expect that late 20102 or early 2013. We try to do that about a year ahead of time. So we would like to have it out by the fall, but the exact date is not set. The trick with ICD-10 is having clients understand the mapping relationship and the decision-making that will have to be involved because the changing codes are taking them to a greater level of specificity. Part of what we’re planning and discussing internally is potentially having an online kind of sandbox, if you will, so that they can upload a current file and see what it would look like with ICD-10 and what kind of decisions they’ll need to make based on my business environment and the types of specialties that I perform, procedures that I do, typical diagnoses, so that they start getting a feel for it.