The Centers for Medicare & Medicaid Services (CMS) has announced what it calls “substantial changes” to the content of the data that must be submitted with claims as well as to the data that it will make available in response to electronic inquiries. The changes are due to the implementation of the Health Insurance Portability and Accountability Act (HIPAA) 5010, and will be implemented starting January 1, 2011.
“The implementation will require changes to the software, systems, and perhaps procedures that you use for billing Medicare and other payers,” CMS said, “so it is extremely important that you are aware of these HIPAA changes and plan for their implementation.”
According to CMS, “all physicians, providers, and suppliers who bill Medicare Carriers, Fiscal Intermediaries (FIs), Medicare Administrative Contractors (A/B MACs), and Durable Medical Equipment MACs (DME MACs) for services provided to Medicare beneficiaries” will be affected by the changes.
In a special bulletin about the changes, CMS said that the Transactions and Code Sets that were published on August 17, 2000, and modified in on February 20, 2003 are now considered outdated and “are widely recognized as lacking certain functionality that the healthcare industry needs.” On January 16, the U.S. Department of Health and Human Services (HHS) announced revisions to the code sets. According to CMS, “Medicare expects to begin transitioning to the new formats January 1, 2011, and ending the exchange of current formats on January 1, 2012…. You are encouraged to prepare for the implementation of these standards or speak with your billing vendor, software vendor, or clearinghouse to inquire about their readiness plans for these standards.”
To view the complete announcement, visit www.cms.hhs.gov/mlnmattersarticles/downloads/se0904.pdf
