5010 - Ready or Not, Here It Comes

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Recently, the Centers for Medicare & Medicaid Services announced they will not take enforcement actions against HIPAA covered organizations that are not 5010-compliant until March 31, 2012. This may sound like you have an extended deadline to become 5010-compliant. But, it is simply advising that there will be a 90-day grace period before enforcement actions will be taken.

The reality is that 5010 is already here. To avoid a traffic jam and potential melt down, the industry began the conversion ahead of schedule to work out the kinks before the official transition date. This means providers may already be experiencing an increase in claim rejections. Monitor your rejection reports for these top five potential road blocks that could hold up your reimbursements.

1. Billing Provider Address

5010 guidelines require providers to enter the billing provider as a physical address. If a PO Box or lock box address is necessary for payments and correspondence from payers, it must be reported as a pay-to address. This rule applies to both professional and institutional claim formats.

2. Ambulance Claims

In 5010, ambulance suppliers who submit medical transportation claims will be required to report the pick-up and drop-off locations for ambulance transport. You will also be required to report the number of patients transported in the same vehicle for ambulance or non-emergency transportation services. There were previously no designated fields for this information, so you will want to ensure that these fields are added to your claims.

3. Drug Reporting

5010 professional claims for injectable medications must include additional drug information and qualifiers, such as NDC code, quantity, composite unit of measure and prescription number, in addition to the HCPCS code. 

4. Zip Code

In 5010, providers must submit a nine-digit ZIP code when reporting billing provider and service facility locations. Providers should work with their software vendors to ensure they can capture the full nine digits for the billing provider and service facility addresses.

5. Anesthesia Minutes

In 5010, anesthesia services must be reported as minutes. Units may only be reported for anesthesia services when the code description includes a time period or indicates that the time is assigned to a primary code.

The resolutions to these data entry changes are rather technical. I encourage your office to work closely with your practice management software vendors and other billing partners, so you continue to get reimbursed in a timely manner.

For more details on other common 5010 rejections, visit gatewayedi.com/5010/faq/.

To view HDM's HIPAA 5010 survival guide slideshow, click here.


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