Pathology/Lab Coding Alert

You might not have until March 31.

You thought you wouldn't face enforcement action regarding 5010 compliance until March 31, 2012. Now CMS tells providers that they are being watched carefully -- and that some of them will not actually have until March to switch to 5010.

CMS Accelerates Changeover

In a Dec. 14, 2011 news release, CMS announced that it is monitoring progress toward 5010 compliance and has found that some practices are unnecessarily dragging their feet.

Whether you've been tested and approved for 5010 or not, you may have heard from your MAC in December to accelerate your transition timeline. Here's the action plan CMS announced in the news release, which will clearly compels some providers to switch prior to March 31:

• "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"
• Submitters/receivers that have not yet tested will be notified in Dec. 2011 "that they must submit their transition plan and timeline to their MAC in 30 days"
• MACs will notify the submitters/receivers and "submitters/receivers have the responsibility to notify the providers they service."

To read more about CMS's plan, visit www.cms.gov/Versions5010andD0.

Grasp 5010 Scope

Version 5010 lays out the technical electronic standards mandated for HIPAA transactions -- that includes claims, eligibility inquiries, remittance advice, and payment data using ICD-10.

Either directly or indirectly, HIPAA Version 5010 will impact nearly everyone involved in healthcare transactions -- providers, clearinghouses, and payers, as well as vendors who provide practice management (PM) systems and other transaction-related software(s), says Kim Dues, CPC, owner of Mass Medical Billing Services in Dickinson, Tex.