Medicare Compliance & Reimbursement

New, standardized reports will show you why your claim was rejected and how to fix it.

You've got a few years to implement the HIPAA 5010 form, but CMS wants to make sure you're completely ready by the time it takes effect on Jan. 1, 2012.

The 5010 form, which will make way for the ICD-10 code set, increases the field size for diagnosis codes from five bytes to seven bytes, allowing for ease of use once the ICD-10 transition occurs. But it also includes other changes that you'll need to know about.

For instance: Once the 5010 goes into effect, you'll have to get familiar with the potential claims rejection notices.

Example: If you receive a 277 claims acknowledgement (CA) rejection, "the billing staff will likely need to produce reports, drawn from the data returned in the 277CA transaction," said Chris Stahlecker, director of Medicare billing procedures, during a Sept. 9 CMS open door forum. "We are expecting that when Medicare fee-for-service issues a 277CA, that the receiver (the providers on this call or their technical representatives) will receive that 277CA and will produce for you a human readable error report so you can understand how to fix your billing error and resubmit that particular claim," Stahlecker said.

Plus: Currently, each MAC produces custom error reports that vary by jurisdiction, but by moving to the use of standardized edits, Medicare is enabling the production of standardized reports across all jurisdictions, Stahlecker said.

Clearinghouses and software vendors can use these transactions to produce reports tailored to their customers, she noted. CMS is currently developing educational materials on 5010, and their availability will be announced via the CMS listserve, said Aryeh Langer, health insurance specialist with CMS, during the call. To read CMS's full HIPAA 5010 PowerPoint presentation, visit

www.cms.hhs.gov/Versions5010andD0/Downloads/5010_September_09_Provider_Outreach.pdf.