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CMS offers 5010 tips for practitioners

April 28, 2012

Although the U.S. Centers for Medicare & Medicaid Services (CMS) has announced it will not enforce compliance with the federal government’s ASC X12 Version 5010 software requirement until June 30, 2012, health care practitioners should act now to ensure a smooth transition, agency officials said.

In a website posting last month, CMS officials emphasized practitioners should check with their billing services and other business partners now to ensure they will have 5010 software in place and will be ready to conduct transactions with the software, according to the CMS.

Practitioners should then test the use of the software with those businesses to file test claims and test other transactions.

When practitioners find a business partner does not have 5010 software in place, they should ask when the business plans to implement the software and then schedule testing, agency officials said.

Because cash flow disruptions could occur as the result of the transition to 5010 software, the CMS also recommended health care practitioners consider establishing or increasing a line of credit with a bank or financial institution to ensure adequate working capital.

“By doing so, they can prepare for possible delays and denials in payer claims reimbursements if noncompliant Version 5010 transactions are submitted,” CMS officials said.

“Although much progress has been made in the successful receipt and processing of claims in the Version 5010 format, CMS is aware that there are still challenges and issues impeding an industry-wide upgrade,” agency officials noted.

AOA members can find additional information as well as a direct link to the CMS ICD-10 page on the AOA 5010 webpage (www.aoa.org/5010).

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