Medicare Compliance & Reimbursement
CMS Expects You to Implement New HIPAA 5010 Form by 2012
Heads Up: Start preparing now, because you won't be able to submit ICD-10 codes without it. If you thought ICD-10 was a distant dream, it's time to snap back to reality: CMS is prepping for ICD-10 -- and so should you. Here's why: You'll have to get used to a new HIPAA 5010 form (which replaces the 4010 form) as a prerequisite to submitting ICD-10 codes, CMS says in MLN Matters article SE0904, issued on May 5. CMS advises practices that they "must be ready to submit claims electronically using the X12 version 5010" effective Jan. 1, 2012. CMS published the final rule for implementing the 5010 transaction standard on Jan. 15, and the new MLN Matters article lays out some of the crucial details you need to know to get ready. The big news regarding the 5010 is that it will allow you to report your ICD-10 codes (ICD-10 will take effect on Oct. 1, 2013). However, the new HIPAA 5010 form has other uses as well. For example: The new form "distinguishes between principal diagnosis, admitting diagnosis, external cause of injury, and patient reason for visit codes," the MLN Matters article notes. CMS hopes to use this data to monitor mortality rates for some illnesses, outcomes for specific treatment options, and hospital stay durations for some conditions. Plus: The new form offers an indicator on institutional claims for "present on admission" conditions. Bottom line: If CMS is announcing the HIPAA 5010 transition information now, chances are the agency is trying to get you to start planning before it's too late. Key: It's imperative that you ask your software vendors whether your billing systems are HIPAA 5010-ready. "This will be bigger than the Y2K changes," predicts Barbara J. Cobuzzi, MBA, CPC,CPC-H, CPC-P, CENTC, CHCC, senior coder and auditor for The Coding Network and president of CRN Healthcare Solutions. To read the MLN Matters article, visit www.cms.hhs.gov/MLNMattersArticles/downloads/SE0904.pdf.
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