Practice Management Alert

Say goodbye to form 4010A1 for ICD codes as well, starting in 2012.

Dig into your claim forms now to ensure that the beneficiary's information is accurate to the letter, or you'll face scores of denied claims on the new HIPAA 5010 forms.

Why it matters: CMS will deny claims on which the beneficiary's name doesn't perfectly match how it's listed on his Medicare I.D. card when you begin using HIPAA 5010 form -- the new Medicare universal claim form starting in 2012.

Include Jr. or Sr. Suffixes

"Whenever there is a name suffix, such as 'Jr.' or 'Sr.' abbreviations, etc., it must be included with the last name," said Veronica Harshman of CMS's Division of Medicare Billing Procedures during an April 28 Open Door Forum regarding the eligibility component of the HIPAA 5010 form.

You can include the suffix either with the patient's last name or in the suffix field, specified CMS's Chris Stahlecker during the call.

"The date of birth must also match exactly to what the Social Security Administration has on file," Harshman said. CMS will use several new error codes on claims once the 5010 form goes into effect. "If you communicate with CMS through a third-party vendor (clearinghouse), it is strongly recommended that you discuss with them how these errors will be communicated to you and how these changes will impact you and your business," Harshman advised.

Look for Production Systems Next Year

According to the HIPAA 5010 Final Rule, CMS will have a production 5010 system available as of Jan. 1, 2011, Harshman said.

The last day CMS will accept a 4010A1 form will be Dec. 31, 2011. As of Jan. 1, 2012, if you aren't using the 5010 form, you'll "lose the ability to receive eligibility data from Medicare," Harshman said. In other words, she noted, mandatory compliance of the 5010 form will begin on Jan. 1, 2012.

Contact your software vendors soon to determine when you can expect your software to be upgraded so it's 5010 ready, Harshman said.

Plus: "Don't forget many of your business processes which may also need to be changed," she noted. For instance, you may want to evaluate how the new form will impact patient registration, billing, appointment scheduling, claims reconciliation, etc., Harshman noted.

Resource: CMS developed several educational products that can help with your 5010 transition, including a side-by-side comparison of the current 4010 form versus the new 5010 form. Visit www.cms.gov/versions5010andD0  for more information.

Watch For Diagnosis Input Changes, Too

You'll also have to get used to using 5010 as a prerequisite to submitting ICD-10 codes, CMS says in MLN Matters article SE0904.

Roadblock: You won't be able to submit ICD-10 codes without this new form, so start preparing. 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 MLN Matters article lays out some of the crucial details you need to know to prepare.

While form 5010 will allow you to report your ICD-10 codes when they take effect on Oct. 1, 2013, you'll also see other diagnosis reporting benefits as well.

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. The new form also offers an indicator on institutional claims for "present on admission" conditions.