Primary Care Coding Alert

Compliance, payment, and ICD-10 hang in the balancesAre you ready to say goodbye to version 4010/4010A1 for electronic transactions? You'll need to be, starting Jan. 1, 2012, when your practice should be fully functional with version 5010 to comply with the Health Insurance Portability & Accountability Act of 1996 (HIPAA) electronic transaction standards.Consequence: If you don't have your 5010 glitches worked out by January, you won't be able to submit electronic transactions to Medicare and potentially other payers, as well.Prepping for ICD-10Version 5010 lays out the technical electronic standards mandated for HIPAA transactions: claims, eligibility inquiries, remittance advice, and payment data using ICD-10. The current version -- 4010/4010A1 -- does not accommodate the ICD-10 code set. That's why CMS will require version 5010 for use by all HIPAA-covered entities (providers, health plans, clearinghouses, and their business associates, including billing agents) as of Jan. 1, 2012. Implementing the 5010 form in [...]