Medical Billing: Say No to Forms 4010/4010A1 for Electronic Transactions from January 1

In a few months from now, (From January 1, 2012), you will bid goodbye to forms 4010/4010A1 for electronic transactions as you will no longer need fully functional form 5010 to comply with HIPAA electronic transaction standards. You won't be able to submit electronic transactions to Medicare if you do not have your problems worked out by that date.

Gear up now

Version 5010 lays out the technical electronic standards mandated for HIPAA transactions that includes claims, eligibility inquiries, remittance advice and payment data using ICD-10.

The present version (4010/4010A1) doesn't accommodate the ICD-10 code set. That is why CMS will need version 5010 for use by all HIPAA-covered entities as of January 1, 2012.

The agency began accepting 5010 forms from January 1 this year and the agency will require the form as of January 1, 2012. The ICD-10 codes will take effect on October 1, 2013 allowing for 5010 testing and implementation time.

Here are some common 5010 pitfalls you need to stay alert to

Under the new 5010 standards, the place of service address can't be a P.O box, it has to be a street address. The claim will be rejected if it is not a street address. How you fix the problem is up to you. The vendor does not have control of the provider master list.

Upgrade your software now: Now is your chance to research form 5010 problems and see if you need a software upgrade while there is time.

You should correct patient information too: Dig into your claim forms now to see to it that the beneficiary's information is spot on to the letter or you will face lots of denied claims on the just-in HIPAA 5010 forms. This is because CMS will deny claims with a beneficiary's name that does not perfectly match how it is listed on the Medicare ID card. What's more, you need to be sure you include suffixes such as Jr or Sr abbreviations along with the patient's last name. Also, the date of birth you put on the claim form must match with what the Social Security Administration has on file.

The agency will use various new codes on claims once the 5010 form goes into effect. And if you use a clearinghouse, you should discuss with them how they will convey these mistakes to you and how these changes will affect your practice.