It has been a month since HIPAA 5010 became the required electronic transaction standard, so I thought it would be timely to report on what Rose Johnson, business office director, and Pat Conover, senior director of IDX services, have told me about our experience. Let me say that overall, the transition has been smooth. However, when I talked with them, I was particularly interested in trends or patterns in claim rejections and, more importantly, their thoughts on what we can do reduce denials.

Here are some things they told me that we need to remember with 5010s:

• Make sure we use nine-digit zip codes.
• Make sure we use the Medicare Secondary Payer (MSP) reason code on primary claim. Formerly, this was for secondary claims submitted directly to Medicare. Now, we must submit an MSP indicator on both the primary and secondary claim when Medicare is reported as the secondary payer.
• Make sure we use detailed description of an unlisted service. In 5010, any claim using an unlisted Current Procedural Terminology  or HCPCS code must also include the code descriptor.
• Make sure we use a physical street address rather than a P.O. Box or lock box address.

It is interesting to see how all pieces of our practice fit together, and while this may be Greek to some of us, others are saying, “Yes, that is what we are doing (or need to be doing).”  I think items like this underscore the importance of our SPIRIT value of teamwork.  Not everybody sees patients and not everyone can diagnose and treat disease, but all are important to our practice and we are thankful that our information technology people, billers/coders and business office are tuned in to what is happening in the industry and making sure we are compliant with requirements.