Home Health & Hospice Week

Deadline will depend on your testing status.

Get ready to start submitting 5010 claims by January if you fall into a certain group of providers, despite the feds' recent announcement of a delay on enforcement of the new claims format.

Then: In November, the Centers for Medicare & Medicaid Services announced a 90-day "discretionary enforcement period" ending March 31 for 5010 use. As long as providers showed they were making a good faith effort to become compliant with the new HIPAA standards, CMS wouldn't penalize them for not using the 5010, the agency said (see Eli's HCW, Vol. XX, No. 42, p. 331).

Now: CMS is whistling a different tune in its latest 5010 deadline announcement. For Part B and durable medical equipment claims, "In December 2011, submitters/receivers that have tested and been approved for 5010/D.0 will be notified that they have 30 days to cutover to the 5010/D.0 versions," CMS says in a Dec. 14 e-mail to providers. Part A will start the same deadline a month later, CMS explains.

The deadline is more lax for providers that haven't tested at all. They will be notified in December (Part B/DME) or January (Part A) "that they must submit their transition plan and timeline to their MAC in 30 days," CMS says.

"Medicare FFS has experienced significant increases in 5010 production transactions during the last few months," CMS notes. But many submitters have tested but not moved into production for 5010, and many submitters haven't initiated testing at all. Therefore CMS is instituting the new deadlines "to ensure that progress continues to be made," it says.

Note: More information on 5010 is at www.cms.gov/Versions5010andD0.