Home Health & Hospice Week

When testing whether you'll be able to appropriately process the new HIPAA 5010 form standards, 25 is the magic number -- that's how many claims you'll want to process to ensure that your system has the new form down.

The Centers for Medicare & Medicaid

Services has introduced its HIPAA 5010 Version D.0 form requirements, which all HIPAA-covered entities must use as of Jan. 1, 2012. CMS will begin accepting 5010 forms effective Jan. 1, 2011, and you'll have to start using the 5010-compliant form by Jan. 1, 2012 at the latest. CMS urges "direct submitters" to contact their Medicare contractor help desk to coordinate testing procedures. "Test with 25 claims minimum,"

said Matt Klischer of CMS's Division of Medicare Billing Procedures during a June 30 CMS Open Door Forum regarding the HIPAA 5010 form. During testing, contractors will use a uniform testing procedure, so if you submit to several different contractors, you'll be able to use the same testing processing, CMS reps confirmed on the call. The UB-04 paper form probably won't see changes due to the new 5010 version requirements.

It currently includes an instruction to precede diagnosis codes with a 0 or 9 "to indicate if it's been drawn from the ICD-9 or ICD-10 code set," CMS's Chris Stahlecker said during the call.

However, the CMS-1500 form doesn't have this instruction. Watch for forthcoming instructions from CMS on "how to use the data of the 0 or the 9," Klischer said.

Get going: "The first recommended deadline for a successful transition to Version 5010 is only five months away," CMS stresses in a message to providers. "By December 31, providers should complete their internal testing, and be ready to test with external partners beginning in January 2011."

"Now is a great time for providers to check in with your vendors about their transition preparations," CMS urges. You can check on your vendor's transition readiness and they can let you know about anything you can be doing to "comply with Version 5010 standards and ICD-10," CMS notes.

Resource: CMS offers a provider/vendor resource page at www.cms.gov/ICD10, CMS notes. It includes "fact sheets with tips on asking each other the right questions."