Part B Insider (Multispecialty) Coding Alert

Published on Tue Aug 16, 2011 PDF

You must request and receive approval for an ASCA waiver before you're in the clear.

If your practice of ten or fewer employees has been sweating the 5010 form conversion, you might be able to breathe easier, CMS reps said during the agency's Sept. 14 National Provider Call regarding HIPAA 5010.

A caller to the forum indicated that she's with a small practice that submits paper claims, and asked how she can logistically convert to 5010, which prompted a reaction from CMS that surprised several listeners.

The facts: Small practices with less than ten employees may fall under the "ASCA (Administrative Simplification Compliance Act) waiver" which means they "technically will still be able to bill the 1500 [form] for professional claims," said CMS's Aryeh Langer during the call. Therefore, the conversion to 5010 "will have little impact, if any," to these small practices, he added.

CMS defines "small providers" as those with less than 10 full-time employees, including physicians. Those practices can apply for the ASCA waiver, which would preclude them from having to file electronically. To apply for an ASCA waiver, visit www.cms.gov/ElectronicBillingEDITrans/07_ASCAWaiver.asp or your MAC's Web site.

Keep in mind: Small practices will still be expected to report ICD-10 codes--"the waiver will not excuse them from switching from ICD-9 to the new system on Oct. 1, 2013. However, an approved ASCA waiver will allow those practices to keep using the CMS-1500 form instead of electronically reporting the 5010.