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HIPAA 5010 Requires IT to Do More with Fewer Resources

Lisa Eramo, for HealthLeaders Media, June 25, 2009

Medicare Administrative Contractors must be ready to use 5010 by January 1, 2011, giving providers one full year to coordinate testing efforts, Stahlecker said.

The Medicare fee-for-service implementation of 5010 will include the following:

  • Improved claims receipt, control, and balancing procedures

  • Increased consistency of claims editing and error handling

  • Improved efficiency for returning claims needing correction earlier in the process

  • Improved assignment of claim numbers closer to the time of receipt

Increased field size

The Medicare implementation will result in an increased field size for ICD-10 codes from five bytes to seven bytes. It will also add a one-digit version indicator to the ICD code to indicate version nine versus 10. Finally, it increases the number of diagnosis codes allowed on a claim from eight to 12.

Each MAC will be required to undergo a certification process using self-developed criteria no later than November 31, 2010 to accommodate the 2011 compliance deadline.

"Although we have multiple MACs with individual systems, we want each one to perform as if it were a virtual single system," Stahlecker said. "No matter which MAC you are exchanging transactions with, you should experience very similar processing results."

In addition, CMS will post on each MAC Web site a list of vendors who have completed their testing for the 5010 format.

"Contact your system vendors right away," Stahlecker said. Ask specifically about whether your licensing agreement includes regulatory updates, she added. "If it does, you may have a shorter path toward your implementation, but if it does not, you may have a long procurement path to follow."

CMS said providers should also inquire whether any potential upgrades include acknowledgement transactions 277CA and 999 as well as a "readable" error report produced from those transactions.


Lisa Eramo, CPC is a senior managing editor in the health information management division of HCPro, Inc. She is located in Rhode Island and writes content for the company's flagship newsletter, Medical Records Briefing. Contact her at leramo@hcpro.com.

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