December 22, 2011

The below information was provided by coding expert Jackie Thelian.  The relevance to many of your practices and timeliness made this a ripe topic for distribution.  I hope you find it helpful!  – Jennifer

5010 Transition Delayed to March 31, 2012

Not That Simple

By: Jacqueline Thelian, CPC, CPC-I

On December 14, 2011 CMS announced they will continue to accept claims submitted in the 4010 version until March 31, 2012. However, those practices who are not 5010 ready by the compliance deadline (which is still in effect) of January 1, 2012 will be required to submit a transition plan to CMS.

By mid-December your Medicare Administrative Contractor (MAC) will notify your practice that a transition plan must be submitted.  If you have not tested with CMS you must submit a transition plan and timeline within the next 30 days by the date on the letter from your MAC.

Failure to turn in a transition plan may result in rejected claims; however, all MACs have been instructed by CMS not to rejected 4010 claims until April 1, 2012.

There is no particular format for a transition plan, however, once your plan has been submitted you will have until March 31, 2012 to be in full compliance with the HIPAA 5010 standard.

If your practice utilizes a clearinghouse to transmit claims, CMS will notify the clearinghouse and not your practice. You are responsible to contact your clearinghouse to determine if they have been contacted.

Practices that have successfully tested and have been approved to send claims in the 5010 format will have 30 days from the date of the MAC letter to fully transition and send all Medicare claims in the 5010 format.

Although the 90 day grace period applies to all insurance plans each plan may have their own contingency plans for practices that are not ready to submit with the 5010 standard. It is recommended you check with all of your insurance carriers and ask what their policy is regarding the 5010 transition.

Ms. Jacqueline Thelian CPC, CPC-I is a Healthcare Consultant, Certified Professional Coder, Author and sought after educator with over 20 years experience in business management and medical coding. She has been involved in physician practice management, billing and reimbursement issues and has taught extensively in academic medical centers, hospitals and private physician practices. For more information, call Medco Consultants at (718) 217-3802.

Copyright © 2011 by Kirschenbaum & Kirschenbaum PC.

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