American Speech-Language-Hearing Association

Medicare Releases Revised 1500 Paper Claim Form

(October 7, 2013)

Audiologists and speech-language pathologists (SLPs) who submit fewer than 10 claims per month to Medicare or who are in private practices with fewer than 10 full-time employees are not required to electronically bill and may use the revised Version 02/12 1500 Health Insurance Claim Form [PDF] (CMS-1500 form) in a transitioned timeline beginning January 6, 2014.

The primary revision accommodates identification of the International Classification of Diseases Ninth Revision, Clinical Modification (ICD-9-CM) or Tenth Revision (ICD-10-CM) and expands to allow 12 possible ICD-9-CM or ICD-10-CM diagnosis codes instead of the current four diagnosis codes. ICD-10-CM codes must be used for dates of service on or after October 1, 2014. Available online are specific instructions based on facility or type of stay. Some of the revisions align the paper CMS-1500 form with certain changes in the electronic version. The date at the bottom right of the new form will be 02/12.

The Medicare transition timeline to the new form and to ICD-10 use is:

  • Beginning January 6, 2014: The current CMS 1500 form with ICD-9 codes only.
  • January 6 through March 31, 2014: During this transition period, providers may use either the old CMS-1500 form (version 08/05) or the new form (version 02/12) and may continue to use ICD-9 codes only.
  • April 1, 2014: Medicare will begin accepting only the revised CMS-1500 Claim Form (ver1sion 02/12), but providers may continue to use ICD-9 codes only.
  • October 1, 2014: This is the date of service after which providers must use ICD-10 diagnostic codes and submit claims only on the revised CMS-1500 form.

Background

The American Medical Association National Uniform Claim Committee, tasked with updating the CMS-1500 Claim Form, identified, as a priority, the need to expand the number of diagnosis codes that can be reported.

The ICD-10-CM has been heralded as a great advance over the ICD-9-CM, because it contains approximately 5 times more codes. The additional codes will yield valuable data for research as well as treatment purposes.

The Administrative Simplification Compliance Act (ASCA) of 2003 limited exemptions for the electronic submission of claims. Only providers who qualify for exemptions from electronic submission may submit the paper CMS-15001 form. Private practitioners and groups with fewer than 10 full-time employees or entities that submit fewer than 10 claims per month (on average during a calendar year) are exempt from electronic submission. The exemption rule applies to providers regardless of the type of payer.

Copies of the CMS-1500 form printed from the Internet are usually unacceptable for actual claims submission due to sensitive red tolerances and other print specifications.

Resources

The National Uniform Claim Committee website includes a sample form.

ASHA will provide audiologists and SLPs with additional information on the use of this new form, as needed, through The ASHA Leader, ASHA Headlines, and ASHA's Billing & Reimbursement website.

For questions, please contact ASHA's health care economics and advocacy team at reimbursement@asha.org.


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