What Does the New CMS-1500 Form Change Mean to Me?

Over the coming months, changes to National Uniform Claim Committee (NUCC) Form CMS-1500 will occur. This form provides medical offices a way of reporting specific information to Medicare, most specifically information about doctors’ diagnoses. It is important for both patients and medical offices to know about these changes and to take steps ensuring the right forms are used when submitting this type of data to the agency. It is very important for both parties to understand what this change will mean to them in the coming year.

Generally speaking, there is not much information the patient needs to know about NUCC Form CMS-1500. In short, this form is an internal form completed by the doctor’s office and submitted directly to Medicare. It provides information about a doctor’s diagnosis to a patient. One of the key components of this form is the coding called ICD-9 (which will change by April 14 to ICD-10). This code is a classification system for diagnostic, surgical and therapeutic procedures, disease entries, and disease codes. Doctors fill out this paper form and submit it to keep Medicare and Medicaid informed.

For all doctors who use a paper form to report this information to Medicare or Medicaid, it is important to know about the upcoming update. On April 1, 2014, the current NUCC Form CMS-1500 will no longer be accepted by Medicare. A new version, known as version 02/12, will be required to be used when submitting this data to the Medicare offices. The current version, known as version 08/05, will no longer be accepted after that date.

Starting January 6^th, until April 1, 2014, the offices will accept both forms. This provides a transition period to allow the medical offices to make the switch properly.

The biggest difference in the new form has to do with its code system. The new form accommodates the use of the new ICD-10 diagnosis codes. This new coding system is important because it will expand the options available. Box 21 of these forms requires the user to state if he or she is using ICD-9 or ICD-10 codes. The new system provides eight more diagnosis codes to the form.

A few other cosmetic changes have also been made to the form. The form is more streamlined to make completing it easier for medical offices. Header and footer information is different and some information boxes are now deleted.

It is best for most medical offices to work towards changing their use of NUCC Form CMS-1500 as soon as possible. All health plans and clearinghouses must maintain use of either form from January 6^th, through April 1, 2014, though. At that point, the medical offices will be required to use the new system. By making the switch now, it can help to ensure the medical office staff gets accustomed to the form changes, as well as the new ICD-10 codes.

For the individual, aside from minor form changes, these changes are not likely to impact their overall Medicare experience. For the medical office though, the changes are notable.