Part B Insider (Multispecialty) Coding Alert

Published on Fri Apr 20, 2012 PDF

CMS may have delayed 5010 enforcement until July 1, but you'd be wise to adopt the new HIPAA-compliant claim format as quickly as possible. "Submitters may continue to submit claims in Version 4010" until July 1, allows MAC Palmetto GBA. But "this is highly discouraged by your MAC," Palmetto stresses on its website. "We will do everything possible to assist you in becoming 5010 compliant."

"It's important that all HIPAA-covered entities continue to take the necessary steps to complete the upgrade to Version 5010 as soon as possible," CMS urges in a message to providers.

Providers may be behind on the 5010 conversion because they have experienced processing difficulties, CMS admits. "Much progress has been made in the successful receipt and processing of claims in the Version 5010 format, [but] CMS is aware that there are still challenges and issues impeding an industry-wide upgrade," the agency says in a separate message to providers.

For example: Providers who haven't received an appropriate EDI authorization to use 5010 can't submit the new claim format, the agency says in a new factsheet troubleshooting 5010 processing problems. A link to the factsheet, "Important Update Regarding Version 5010/D.0 Implementation," is at www.cms.gov/Regulations-and-Guidance/HIPAA-AdministrativeSimplification/Versions5010andD0/.

Tip: "To avoid potential cash flow disruptions, providers should consider establishing or increasing a line of credit," CMS says in a factsheet about the transition. "By doing so, they can prepare for possible delays and denials in payer claims reimbursements if noncompliant Version 5010 transactions are submitted." The factsheet, which includes other tips, is at www.cms.gov/Medicare/Coding/ICD10/Downloads/SmoothTransition.pdf.

CMS will hold a national provider call about 5010, including "outstanding fixes impacting the Part A and Part B Version 5010 transition," on April 25. You can register for the call at www.eventsvc.com/blhtechnologies.