Home Health & Hospice Week

You'll want to start double- and triple-checking your claims to ensure the beneficiary's information is spot-on, or you'll face scores of denials once the new HIPAA 5010 takes effect.

That's because the Centers for Medicare & Medicaid Services plans to deny claims filed on HIPAA 5010 forms on which the beneficiary's name doesn't perfectly match how it's listed on his Medicare I.D. card. (The 5010 will be the new Medicare universal claim form starting in 2012.)

"Whenever there is a name suffix, such as 'Jr.' or 'Sr.' abbreviations, etc., it must be included with the last name," said Veronica Harshman of CMS's Division of Medicare Billing Procedures during an April 28 Open Door Forum regarding the eligibility component of the HIPAA 5010 form.

You can include the suffix either with the patient's last name or in the suffix field, specified CMS's Chris Stahlecker during the call.

"The date of birth must also match exactly to what the [Social Security Administration] has on file," Harshman said.

CMS will use several new error codes on claims once the 5010 form goes into effect. "If you communicate with CMS through a third-party vendor, it is strongly recommended that you discuss with them how these errors will be communicated to you and how these changes will impact you and your business," Harshman advised.

According to the HIPAA 5010 final rule, CMS will have a production 5010 system available as of Jan. 1, 2011, Harshman said. The last day CMS will accept a 4010A1 form will be Dec. 31, 2011. As of Jan. 1, 2012, if you aren't using the 5010 form, you'll "lose the ability to receive eligibility data from Medicare," Harshman said.

Bottom line: In other words, she noted, mandatory compliance of the 5010 form will begin on Jan. 1, 2012. Contact your software vendors soon to determine when you can expect your software to be upgraded so it's 5010 ready, Harshman said.

Plus: "Don't forget many of your business processes which may also need to be changed," Harshman noted in the forum.

For instance, you may want to evaluate how the new form will impact intake, billing, claims reconciliation, etc., Harshman noted.

Resource: CMS developed several educational products that can help with your 5010 transition, including a side-by-side comparison of the current 4010 form versus the new 5010 form. Visit www.cms.gov/versions5010andD0 for more information.