Part B Insider (Multispecialty) Coding Alert

Published on Fri May 15, 2009 PDF

Yes, physicians are affected by the new form -- but so are billers and claims clearinghouses.

CMS wants you to clear one big hurdle before you can even consider submitting ICD-10 codes: You'll need to get used to the HIPAA 5010 form before Jan. 1, 2012.

During a June 9 CMS open door forum, CMS officials outlined the important features of the new HIPAA 5010 form.

Version 5010 is an improvement over the current 4010 form "because it brings many things to the table, including structural and content oriented changes," noted Kyle Miller, health insurance specialist from CMS's office of e-health standards and services, during the call. "In addition, version 5010 will address shortcomings from version 4010."

You'll have to start using version 5010 on Jan. 1, 2012, but CMS expects Medicare carriers to begin transitioning to the 5010 form in 2011. That way, you should be able to start submitting early to ensure that your billing software systems work appropriately with the new form and your carrier's claims submission service before the requirement deadline of 2012.

"All HIPAA-covered entities are affected by the new 5010 form, including providers, health plans, and clearinghouses," said Chris Stahlecker, director of the division of Medicare billing procedures with CMS's office of information services, during the call. "In addition, any billing service agents will also be affected by the new form," she said.

"The formats that you're currently using to bill Medicare or to perform Medicare eligibility inquiries must be changed from the 4010A1 format to the 5010," Stahlecker said.

You'll need to identify software and business process changes ahead of time to recognize the new form's data element changes.

Plus: CMS is "currently working on developing a new 5010 Web page that will distinctly differentiate between information for Medicare fee-for-service providers and the health care industry at large," said Aryeh Langer of CMS's provider communications group.