4 Tips for Submitting HIPAA 5010 Claims

 Submitting HIPAA 5010 claims

The Centers for Medicare and Medicaid Services (CMS) recently announced it will provide a 90-day grace period for enforcement of HIPAA 5010. This doesn’t mean providers don’t have to comply with the requirement.

CMS will accept complaints about non-compliance with the rule and could require Covered Entities to show evidence of a good-faith effort to comply. In addition, any claim or bill submitted after January 1, 2012 not in HIPAA 5010 will still get rejected, but this delay will allow for resubmitting in the appropriate format without penalty.

Below are four tips to ensure reimbursement continues to occur at your organization after January 1, 2012:

1. With HIPAA 5010, the 837 transaction set now requires anesthesia services to be reported in minutes instead of units.

2. With the start of HIPAA 5010, the 835 transaction set offers new data elements; these will provide payers the ability to allow direct billing by a Medicaid agency to other health plans.

3. For Version 5010, the 837 transaction set provides for a present-on-admission indicator related to each diagnosis code.

4. The 270/271 transaction sets, with Version 5010, clarify instructions for patient hierarchy, such as when a subscriber is a patient and when a dependent is a patient.