5010 Discretion Period Doesn’t Change Implementation Date

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In Billing
December 15, 2011
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The recent announcement of a discretionary period for Version 5010 by the Centers for Medicare & Medicaid Services (CMS) means fines for noncompliance will not be levied through March 31, 2012. However, providers will still be penalized for failure to adopt the new Medicare transaction standard by the Jan. 1, 2012 deadline, industry sources tell EdgeBlast.

What does the discretionary period mean for Medicare fee-for-service (FFS) providers?

The 90-day reprieve isn’t much of one because providers may see rejections for failing to implement the standard’s provisions.

Medicare FFS has experienced significant increases in 5010 production transactions during the last few months, CMS says. The agency says submitters have tested, but have not taken, the step to move into production for 5010 and its component, D.0. In addition, many submitters have not yet initiated testing with their Medicare administrative contractor (MAC). To ensure progress continues to be made, CMS says it is planning to take the following steps for submitters and receivers of Medicare Part B and durable medical equipment (DME) transactions (Submitters and receivers of Medicare Part A transactions will follow the same action plan starting 30 days after Part B and DME.):

  • In December 2011, submitters/receivers that have tested and been approved for 5010/D.0 will be notified that they have 30 days to cutover to the 5010/D.0 versions.
  • Submitters/receivers that have not yet tested will be notified in December 2011 that they must submit their transition plan and timeline to their MAC in 30 days.
  • MACs will notify submitters/receivers; and submitters/receivers have the responsibility to notify the providers they service.

Be sure your office is ready to incorporate the changes needed for 5010, which include the following:

  • Billing Provider Address - The new guidelines require providers to enter the billing provider’s mail location as a physical address, rather than post office (PO) boxes or lock boxes. 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.
  • ZIP Code - Providers must submit a nine-digit ZIP code when reporting billing provider and service facility locations.
  • Drug Reporting - Professional claims for injectable medications must include additional drug information and qualifiers, such as National Drug Code (NDC), quantity composite unit of measure and prescription number, in addition to the HCPCS Level II code.
  • Anesthesia - Anesthesia services are reported as minutes, not units, in 5010. Units may only be reported for anesthesia services when the code description includes a time period or indicates the time is assigned to a primary code.
  • Ambulance - New fields in 5010 require pick-up and drop-off locations to be documented and the number of patients transported in that particular service to be noted.

CMS made the decision to add a discretionary period “based on industry feedback revealing that, with only about 45 days remaining before the January 1, 2012 compliance date, testing between some covered entities and their trading partners has not reached a threshold whereby a majority of covered entities would be able to be in compliance by January 1.” Testing has been on-going since June, with CMS organizing special days.

You can find out about the discretionary period, and you can download free publications and information to help you become compliant in time by going to the CMS website.

One Response to “5010 Discretion Period Doesn’t Change Implementation Date”

  1. […] The recent announcement of a discretion period for Version 5010 by the Centers for Medicare & Medicaid Services (CMS) means no fines for noncompliance will not be levied through March 31, 2012. However, providers will still be penalized for failure to adopt the new Medicare documentation standard by the Jan. 1, 2012 deadline, industry sources tell EdgeBlast. What does the discretionary… Read more » […]

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