Medicare Compliance & Reimbursement

If you're considering testing whether your practice will be able to appropriately process the new HIPAA 5010 form, 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.

CMS has introduced its HIPAA 5010 Version D.0 form, which will be required to use by all HIPAA-covered entities (i.e., providers, health plans, clearinghouses, and their business associates, including billing agents) as of Jan. 1, 2012. CMS will begin accepting 5010 forms effective Jan. 1, 2011, and use of the form will be required as of Jan. 1, 2012.

CMS urges "direct submitters" to contact their MAC 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, MACs will use a uniform testing procedure, so if you submit to several different MACs, you'll be able to use the same testing processing from state to state, CMS reps confirmed on the call.

The National Uniform Claims Committee is looking into whether the CMS-1500 form will be changed along with the 5010 form, but it's unclear at this point whether you'll find a new 1500 form in the future, CMS reps indicated during the call.

The UB-04 paper form 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, there is not such an instruction on the CMS-1500 form. "When the time comes for ICD-10 implementation, there will be instruction put out by CMS to instruct how to use the data of the 0 or the 9," Klischer said.

(Editor's note: To view the presentation from the June 30 call, visit www.cms.gov/Versions5010andD0/Downloads/6-30-10_5010_national_presentation_837I.pdf.)