As ICD-10 goes into effect on October 1, 2013, you will need
to start your transition with a piece of health insurance reform legislation
called 'Version 5010'. This form lays out the technical electronic transaction
standards mandated for Health Insurance Portability & Accountability Act of
1996 (HIPAA) transactions and includes requirements for transmission of claims
and payment data using the soon-to-go-into effect ICD-10 code set. This form
will affect almost everyone involved in healthcare transactions.
Why 5010 form?
The present system version 4010/4010A1 lacks functionality
for some transactions; more importantly, it does not accommodate the ICD-10
code set. This system will therefore be replaced by version 5010 for
eligibility enquiries and remittance advices. The new version will take up
various problems and complexities found in the earlier version. Additionally,
the just-in form also comes with other diagnosis reporting advantages.
When: Although Centers for Medicare & Medicaid (CMS) has
started accepting 5010 forms from January 1, 2011, the deadline for you to
start using this form is January 1, 2012.
Need of the hour: However, it's being seen that too many
billers and providers are taking this deadline casually. What happens in case
you fail to submit the 5010 form by the set deadline? When that happens, you
will no longer be able to submit electronic transactions to Medicare; you will
also receive delayed or reduced payments, audits will frequent you and your
practice and there are chances your relationship with your vendors and payers
will turn sour. What's more, your practice is also likely to witness a dip in
productivity in case of a failure to use this form.
Communicate with your vendors immediately: So if you want to
switch to 5010 format successfully, you need to communicate with your vendors
first.
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