ICD-10 delay proposed, but that's not all

By now you have likely heard the Office of the Secretary of the Department of Health and Human Services (HHS) has formally proposed delaying the transition date for ICD-10-CM to Oct. 1, 2014. Good news for the practices that have not started or do not know when they will start preparing for ICD-10 (76 percent, according to today's reading of FPM's Reader Poll; vote and view the latest results in the left column of FPM's home page). You have an added year to get your plans in order and get caught up in preparing for this transition.

But this is not the only portion of this proposed rule that affects your practice. This rule also adds the implementation date for national unique health plan identifiers (HPID). By Oct. 1, 2014, all large health plans (i.e., payers) must apply for an HPID, just as physicians have applied for their national provider identifier (NPI). In addition, claims administrators, clearinghouses, and other entities involved in the claims process wil have the opportunity to adopt a national Other Entity Identifier (OEID). While this is good news in that it should eliminate some of the issues that occur with claims transmissions not routing to the correct claims administrators or payers, it will come with some costs to your practice.

By Oct. 1, 2014, your billing system must be equipped to include these numbers on your claims. Small health plans have until Oct. 1, 2015, to comply, which complicates matters because you may need to send the HPID on most but not all claims. If your software vendor or clearinghouse didn't fare well in the transition to the HIPAA (Health Insurance Portability and Accountability Act) 5010 electronic transactions standards, now would be a good time to discuss with them when they will start planning and working to achieve compliance with the HPID. The timeline provided in the proposed rule indicates that your systems should be ready to send test transmissions of claims with the HPID by April 1, 2013.

If you have comments on any of these proposals, the rule includes a comment period of 30 days from the date of publication in the Federal Register. Comments should include file code CMS-0040-P and may be submitted electronically on http://www.regulations.gov or in writing to Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-0040-P, P.O. Box 8013, Baltimore, MD 21244-8013.

While you'll have an extra year to get ready for ICD-10, there is another sizable task on the to-do list – to prepare your claims systems to submit the HPIDs. I guess it is true that what one hand giveth, the other taketh away.

Posted at 04:32PM Apr 23, 2012 by Cindy Hughes  |  Comments[0]

ICD-10: The gift of time

In February, I posted that the U.S. Department of Health and Human Services (HHS) had signaled its intent to delay implementation of International Classification of Diseases, 10^th Edition (ICD-10), which was scheduled to happen on Oct. 1, 2013. Now HHS made it almost official.

HHS Secretary Kathleen Sebelius announced a proposed rule that would delay the compliance date for ICD-10 from Oct. 1, 2013 to Oct. 1, 2014. The proposed rule is subject to a 30-day comment period before HHS finalizes it and makes the proposed delay completely official. 

As Cindy Hughes has noted in her most recent article in Family Practice Management, "While the delay may give you more time to prepare, it most certainly does not mean that you can postpone this work; it just means that if you start now, you might actually be ready by the new deadline." Cindy's article provides some great information in this regard, and you can find more information and resources on the American Academy of Family Physicians website.

So, HHS has provided the gift of another 365 days to prepare for implementation of ICD-10. Physicians and others would do wisely to use this gift to their advantage in getting ready. It seems unlikely that HHS will be this generous again in advance of the new deadline.

Posted at 09:53AM Apr 17, 2012 by Kent Moore  |  Comments[0]

Comprehensive Primary Care Initiative resources

To help practices in the seven Comprehensive Primary Care Initiative (CPCI) markets announced this week, the American Academy of Family Physicians and TransforMED will offer a free webinar at 1 p.m. CDT on May 10, 2012. Bruce Bagley, MD, will present "CPCI Selected Markets: Preparing Your Practice for Participation." A webinar from Feb. 1, 2012, is also available for viewing – "The Comprehensive Primary Care Initiative: Qualification Requirements and How You Can Benefit." For more information about CPCI and these resources, visit http://www.aafp.org/cpci.

Posted at 09:36AM Apr 13, 2012 by Leigh Ann Backer  |  Comments[0]

Comprehensive Primary Care Initiative: Coming soon to a market near you?

The Center for Medicare & Medicaid Innovation (CMMI) has identified the markets where it will test its Comprehensive Primary Care Initiative (CPCI), according to information posted yesterday on the CMMI website. CPCI, which was announced last fall, will test a payment model that offers physicians a monthly care management fee for each Medicare fee-for-service patient in their care as well as a share of any savings that the initiative generates. The following markets were chosen based on applications from payers:

• Arkansas,
• Colorado,
• New Jersey,
• New York (Capital District/Hudson Valley Region),
• Ohio (Cincinnati/Dayton region),
• Oklahoma (Greater Tulsa region),
• Oregon.

Approximately 75 practices in each market will be chosen to participate. CMMI will solicit applications from practices as soon as final agreements are signed with the participating payers, which include private health plans, state Medicaid agencies, and employers, as well as Medicare.

CPCI is a four-year initiative with a planned launch date this summer.  If it is shown to improve quality of care and lower costs, CMMI has the authority to roll out the initiative nationwide. Read more about the initiative in Family Practice Management.

Posted at 10:49AM Apr 12, 2012 by Leigh Ann Backer  |  Comments[0]

Additional Documentation Requests: Don't ignore them

Family physicians in the Medicare J5 MAC region states of KS, MO, NE, and IA providing inpatient care should be prepared to receive and promptly respond to letters from the WPS Medicare Medical Review Department. These will be related to prepayment review of claims for subsequent hospital visits submitted with code 99233. WPS notes that their Comprehensive Error Rate Testing (CERT) reviews of paid claims have shown a significant increase in errors on claims for these services by family physicians. If one of your claims is selected for review, WPS will send an Additional Documentation Request (ADR) for medical records for all dates of service billed with CPT code 99233.

Breathing a sigh of relief because you are not in one of the J5 MAC states? I can see that. No one wants their payments delayed and subjected to prepayment review and potential denial or down-coding. But if your Medicare CERT or one of the myriad other Medicare auditors isn’t looking at your inpatient hospital services, I would bet they are looking at some other evaluation and management (E/M) service that may have been inadequately documented or incorrectly coded. If post-payment review results in a high error rate, you too may find your payments delayed, reduced, or denied.

So what can you do to avoid problems?

First respond promptly and completely to all ADR letters. Many claims are denied and counted as errors due to lack of response to ADR's. See the information previously provided in this blog for details. 

Second, be sure that documentation submitted is clear, complete, appropriately signed, and dated. Did you and your partner provide E/M services on the same date and bill the services according to Medicare rules as one E/M service? Will both notes be sent? If not, your 99233 visit may be down-coded to 99231 or 99232. A records request checklist can help your staff submit all of the information necessary to support your charges.

Are you using 99233 only when the patient is unstable or has developed a significant complication or a significant new problem? If billing based on time, have you documented counseling and coordination of care for at least half of a visit (including hospital floor time) of 35 minutes or more?

Finally remember, code 99233 requires at least two of these three components:

• A detailed interval history – state progress or complications since last visit, if referring to previous history state date of previous history, chief complaint or reason for visit beyond “follow-up,” HPI (4 items or 3 conditions), ROS (2-9 systems), PFSH (none necessary);

• A detailed examination – Extended exam of problem system/areas plus others;

• Medical decision making of high complexity (2 of 3 elements, not risk alone) – established problem(s) worsening; new problems with or without further work-up; changes in treatment, nursing instructions, decisions for palliative care, tests and procedures ordered (note if urgent), tests reviewed and unexpected results, discussions with other physicians, risks of management and treatment.

It is complex and probably annoying but remember, it is necessary to show the work (talking, reviewing, thinking) that you did to support your charges. A 99233 service should not go unpaid due to lack of response to ADRs, unsigned records, or other documentation gaps.

Posted at 04:23PM Mar 30, 2012 by Cindy Hughes  |  Comments[2]

EHR incentives and PQRS can work together

I have written before about the Medicare Physician Quality Reporting System (PQRS) and the advantages of the registry-based or electronic health record (EHR)-based reporting options. Though the incentive payment for successful reporting in 2012 will be only .5% of your total allowed charges for covered Medicare Part B services provided during the reporting period, there are other reasons to report.

First, those of you who are participating in the Medicare EHR incentive program may be able to satisfy the core requirements for reporting clinical quality measures (CQMs) through Medicare's Physician Quality Reporting System – Electronic Health Record (EHR) Incentive Pilot. Beginning in 2012, eligible professionals may satisfy the meaningful use objective to report the 44 CQMs to the Centers for Medicare & Medicaid Services (CMS) in two ways:

1. Using the Medicare and Medicaid EHR Incentive Programs’ web-based Registration and Attestation System, or

2. Participating in the Physician Quality Reporting System – Medicare EHR Incentive Pilot, which utilizes the 2012 Physician Quality Reporting System EHR Measure Specifications.

By submitting specific Physician Quality Reporting EHR Measures through the pilot, participants can focus on the same sample of beneficiaries for the Medicare EHR Incentive Program and for the Physician Quality Reporting System for the 2012 program year. Eligible professionals participating in the Physician Quality Reporting System – Medicare EHR Incentive Pilot are still required to report the other meaningful use objectives through the Medicare and Medicaid EHR Incentive Programs Registration and Attestation System.

Second, beginning in 2013, failure to successfully report PQRS measures will result in an adjustment (penalty) of -1.5 percent on all Medicare payments in 2015.

Third, even those without a qualified EHR system can successfully participate in the PQRS program without the hassles of the claims-based reporting that has proven quite burdensome and unsuccessful for many practices. The registry-based option allows for successful reporting with selection of a measures group for which you will report on 30 Medicare patients using an online registry program such as the AAFP PQRIwizard.

You can find more information on the PQRS program and the EHR-based and registry-based reporting options on the CMS PQRS Alternative Reporting Mechanisms page. Don't give up the full amounts allowed under the Medicare Physician Fee Schedule.

Posted at 02:17PM Mar 08, 2012 by Cindy Hughes  |  Comments[0]

Another patch and another cliff

Last week, a U.S. House-Senate Conference Committee reached a 10-month deal that would maintain current physician payment rates through the end of the year. The measure, H.R. 3630 (at the THOMAS website, type "H.R. 3630" into the search field after selecting "Bill Number"), was subsequently approved by both the House and Senate. Yesterday, the President signed the bill into law.

This latest patch to the Medicare physician fee schedule avoids the 27.4 percent Medicare physician payment cut that was otherwise scheduled to occur on March 1 as a result of the sustainable growth rate (SGR) formula. Because H.R. 3630 postpones but does not eliminate the threat posed by the SGR, physicians will face a 32 percent Medicare payment reduction when the payment patch expires at the end of this year, which makes Jan. 1, 2013, the next "cliff" that physicians will face in terms of Medicare payments.

As noted, the law does not solve the underlying problem. It only postpones its resolution and adds to the cost of a permanent solution. The cost of repealing the SGR will climb from $316 billion today to $335 billion in 2013. In the meantime, physicians are left to cope with the ongoing uncertainty and hope that Congress will find the fortitude and funds for a permanent solution before 2013 rolls around.

Posted at 04:05PM Feb 23, 2012 by Kent Moore  |  Comments[0]

E-Prescribing codes for 2012

Wondering what codes to report to demonstrate e-prescribing in 2012? If you electronically prescribed during the eligible patient visit, submit code G8553, which denotes that at least one prescription created during the encounter was generated and transmitted electronically using a qualified e-prescribing system. Eligible patient visits are those reported with any of the following CPT or HCPCS codes:

90801, 90802, 90804, 90805, 90806, 90807, 90808, 90809, 90862, 92002, 92004, 92012, 92014, 96150, 96151, 96152, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, G0101, G0108, G0109.

To demonstrate that you are exempt from e-prescribing, submit code G8642, which connotes that "the eligible professional practices in a rural area without sufficient high-speed Internet access" and G8643, "The eligible professional practices in an area without sufficient available pharmacies for electronic prescribing. There are no codes to report exemptions resulting from the inability to electronically prescribe due to state, federal, or local law or regulation" or as an "eligible professional who prescribes fewer than 100 prescriptions during a six-month payment adjustment reporting period." These exemptions must be requested by the physician through http://www.qualitynet.org/pqrs.

A Remittance Advice (RA)/Explanation of Benefits (EOB) with the denial code N365 is your indication that the e-prescribing G-code was received by Medicare.

Posted at 02:33PM Feb 22, 2012 by Cindy Hughes  |  Comments[0]

ICD-10 delay may be in the works

With 5010 implementation effective Jan. 1, 2012, the next major hurdle facing physicians and the rest of the health care system is implementation of International Classification of Diseases, 10^th Edition  (ICD-10). Currently, that is slated to happen on Oct. 1, 2013.

Or is it? This week, officials at the Centers for Medicare and Medicaid Services (CMS) and Health and Human Services (HHS) announced that a delay in implementation may be forthcoming. First, on Tuesday, acting CMS Administrator Marilyn Tavenner told reporters that the CMS will "re-examine the timeframe" for ICD-10 implementation through a rulemaking process. She did not say when that rulemaking process will begin, and she did not actually say that implementation will be delayed.

Then, on Wednesday, HHS Secretary Kathleen G. Sebelius announced that HHS will initiate a process to postpone the date by which certain health care entities have to comply with ICD-10. In a press release, the agency stated, "HHS will announce a new compliance date moving forward."

So, it appears that a delay in implementation is in the works. However, how much of a delay and to whom it will apply remain unknown. Pending answers to those questions in the form of a posting in the Federal Register, physician practices are probably best advised to continue preparing for implementation on Oct. 1, 2013. Like the Boy Scouts, it is better to be prepared, lest the anticipated delay does not come to fruition.

Posted at 12:51PM Feb 16, 2012 by Kent Moore  |  Comments[0]

Prior authorization: It's not just for private payers anymore

Prior authorization has been a longstanding tool used primarily by private payers for a variety of purposes, including controlling costs. To date, public payers, such as Medicare, have used it less frequently. Based on a recent announcement from the Center for Medicare & Medicaid Services (CMS), that may be changing. CMS is getting ready to launch two new demonstration programs that may impact physicians and make them further justify claims submitted for payment.

Posted at 09:28AM Feb 10, 2012 by Kent Moore  |  Comments[0]

New HCPCS codes worth noting

The Centers for Medicare & Medicaid Services (CMS) has released a quarterly update providing new Healthcare Common Procedure Coding System (HCPCS) codes for January 2012. Often the HCPCS updates don't have much to offer family physicians, but this group may be worth noting.

You have probably seen the announcements of new Medicare coverage for preventive services such as intensive behavioral therapy for cardiovascular disease risk and obesity, screening for depression, and screening for sexually transmitted infections. What is missing for some of these newly covered services is the guidance on what must be included and documented for the services, the codes used to report them, and the payment amounts for each. AAFP staff have put together a table of what we know so far about the codes, who can provide the services and in what settings, and how often each service is covered. There is still a lot we do not know, including when these services will be bundled with other services provided on the same date, but CMS should soon publish that information in the April 2012 National Correct Coding Edits.

Other notable 2012 HCPCS codes include the following:

G0449: Annual face-to-face obesity screening, 15 minutes – notable because this new code is listed in the fee schedule as a non-covered service,

G0451: Development testing, with interpretation and report per standardized instrument form – notable because this may be required by Medicaid or health plans in lieu of CPT 96110 due to the change in the CPT code descriptor to "Developmental screening, with interpretation and report, per standardized instrument form,"

G9156: Evaluation for wheelchair requiring face-to-face visit with physician – notable because this code is used to report services related to a CMS action to correct improper payments for power mobility devices. Medicare contractors in the following states, CA, FL, IL, MI, NY, NC, and TX, began 100 percent prepayment review for initial rental or purchase claims after Jan. 1, 2012 and prior authorization of power mobility devices beginning April 1, 2012. This may be implemented in other states in the future. To compensate physicians for time associated with preparing and submitting a prior authorization request, code G9156 is reported after submission of the initial prior authorization request with the prior authorization tracking number provided by the Medicare durable medical equipment contractor. Claims are submitted to the Medicare Part B contractor and only one claim with code G9156 may be billed per beneficiary per power mobility device even if a physician must resubmit the request for prior authorization. For more information from CMS, see this presentation.

There will likely be more changes to come in 2012, especially to the preventive service benefits as defined by the Affordable Care Act. Here's hoping the benefits to patients outweigh the complexity of the Medicare benefit structure!

Posted at 05:55PM Jan 26, 2012 by Cindy Hughes  |  Comments[2]

What the 2012 Medicare Physician Fee Schedule tells us about the future

The final rule for the 2012 Medicare Physician Fee Schedule went on display this week. Of course it includes the all-too-familiar fee cut (27.4 percent) – the result of the Centers for Medicare & Medicaid Services' (CMS) flawed formula for calculating physician payment that Congress has been patching annually since 2002 but which needs a permanent fix. This year's fee schedule is notable for another reason as well. The PDF file is 1,235 pages long, and that's without the appendices that will be included when the final rule is published in the Federal Register later this month. The fact that it requires so many pages to describe one year's changes to one part of one government program is mind-boggling, but the additional bulk is partly because this year the rule also provides a forecast for how CMS plans to carry out government mandates for the program over the next five to 10 years. It is not a crystal ball, but the rule leaves no doubt that Medicare payment to physicians will be changing and that today's initiatives and incentives are intended as the basis for tomorrow's payment.

Examples of this are especially clear in the portion of the rule that speaks about a value-based payment modifier, which will actually modify payments under the Medicare Physician Fee Schedule based on Medicare's record of the quality of care you provide to patients compared with the cost of that care. Where will Medicare get this data? Primarily from the quality measures reported for programs like the Physician Quality Reporting System and the EHR Incentive Program and from claims data for your patients. Physicians who are found to deliver high quality for the cost of care will be paid more than other physicians. The program is budget neutral, so one physician's gain is another physician's loss.

CMS is still working out the details, such as how to attribute patients to physicians, adjust for risk and complexity, and make the measurements meaningful for all specialties. What is clear from the rule is that the process is underway to put the value-based modifier in place by 2015 for some physicians (based on claims and quality reporting in 2013) and by 2017 for all physicians (probably based on claims and quality reporting in 2015).

 CMS has this to say in the final rule:

"We strongly encourage physicians to participate in the Physician Quality Reporting System program and the EHR Incentive Program sooner rather than later and to choose to report quality of care measures that best reflect their practice and patient population. Although we have not yet proposed the value modifier methodology, our primary interest at this point is to increase the quality of care for Medicare beneficiaries. We note that we also plan to propose a value modifier in rule making during 2012, prior to the initial performance period. Thus, we believe it is reasonable to encourage physicians to report appropriate quality measures well in advance and irrespective of the exact value modifier methodology at this time."

The complexity and unknowns of this value based payment system are daunting.  However, this could be a good thing if physicians who know their patients and provide comprehensive, coordinated care are rewarded for their work. Sounds like family medicine to me.

Posted at 11:06AM Nov 11, 2011 by Cindy Hughes  |  Comments[1]

5010 and 2012: Time for a backup plan?

As we near the end of 2011, you may notice a lot of fuss about the transition to the HIPAA version 5010 electronic transactions. The reason is that your claims must reach your payers in the 5010 format beginning on Jan. 1, 2012, or they will be rejected. As the deadline approaches, it may again be time to assess your practice's readiness to submit and receive electronic claims and other transactions in the HIPAA 5010 format. Has your vendor upgraded your claims software, and have you begun testing with your clearinghouse and payers? If not, what is the vendor's message to you about having this work completed before the deadline? How confident are you that you will be able to send and receive claims data to keep payments coming in after the first of the year? If your confidence isn't high, it is probably time to consider a backup plan. Here are some options for those practices whose software vendors are not showing promise:

1. Contact the clearinghouse through which your claims are submitted to find out if it will offer conversion services. Most clearinghouses will be able to receive claims in the current 4010A format and convert them to the 5010 format before relaying the data to the payers. Likewise, when the payers send back acknowledgements or claims reports in 5010, the clearinghouse may convert that data back to 4010A before delivering it to your practice. (They will likely be doing the reverse for payers that are not ready for 5010.)

2. If your software vendor is requiring a costly upgrade, consider whether it is time to look at other options. (This may be especially relevant if an EHR is in your near future. You may want evaluate how EHRs integrate with practice management systems.)

3. Use free software from your Medicare contractor to submit your Medicare claims. This will keep at least that portion of your cash flow intact. Though the software is free, using it will likely require extra data entry work, since the software does not connect to your billing system.

4. If your vendor is planning a last-minute upgrade and you have some level of confidence that any delay beyond the first of the year will be short, you may want to hold your billing for that time and let other claims be applied to patient deductibles. Your billing staff can use the time to work with the software vendor and clearinghouse and also do some intensive follow-up on this year's unpaid balances. (This could result in a better-than-typical January cash flow.)

Some have recommended that physicians secure a line of credit just in case of a disastrous transition. This may not be needed and is probably easier said than done; however, a line of credit is always a good idea and could be needed for many other reasons (e.g., a severe reduction in the Medicare fee schedule, RAC audits, and other disasters like flooding). If you have the credit and banking relationship to secure a line of credit, it might be worth discussing with your banker.

Many of you have survived Y2K, the first HIPAA transition, the introduction of the national provider identifier (NPI), and the Medicare enrollment process. I am confident that you will get past 5010 as well. I think the doomsday authors are wrong about the world ending on Jan. 1, 2012. Even if they are right, 5010 won't be to blame. Let's save the paranoia for the real scary stuff, like Congress in session and arsenic in apple juice.

Posted at 03:11PM Oct 17, 2011 by Cindy Hughes  |  Comments[0]

Your Medicare participation options

A couple of recent news items have me asking again a question previously asked on this blog in October of 2010. "Why would any physician in his [or her] right mind want to participate in a system such as this [Medicare]?"

First, the ever-voluminous proposed rule for the Medicare Physician Fee Schedule has been published and is now open to comment. Looming above all the program changes and some potential additional work that is proposed is the ever-constant threat of a pay cut due to the sustainable growth rate (SGR). If Congress, also charged with reducing a massive budget deficit, does not act to either fix the SGR or again delay the related decrease in payments, the Medicare Physician Fee Schedule will be reduced by 29.5 percent. Doesn't sound like a reasonable business proposition to me.

Second, CMS announced this week that all physicians and providers who completed the enrollment process before March 25, 2011 will once again have to re-validate their enrollment in PECOS. (PECOS may stand for Particularly Exacerbating CMS Online System.) CMS notes that this is to comply with Section 6401(a) of the Affordable Care Act, which increases screening of physicians and providers enrolling in Medicare and Medicaid. (Note: You must complete this work when your Medicare contractor notifies you to do so and not before then, but then you must not be late either. "Upon receipt of the revalidation request, providers and suppliers have 60 days from the date of the letter to submit complete enrollment forms. Failure to submit the enrollment forms as requested may result in the deactivation of your Medicare billing privileges. ")

So what is the alternative? There are three Medicare participation options. The first is to participate, which means enrolling, accepting the Medicare fee schedule for all Medicare patients and being paid directly from Medicare. The second is to enroll but not participate, which allows you to charge the patient a fee up to the Medicare limiting charge and submit a claim for the patient to receive the reduced payment from Medicare. The third is to opt-out of Medicare for periods of two years and privately contract with your Medicare patients. To opt out, a physician must file an affidavit that meets the necessary criteria and is received by the carrier at least 30 days before the first day of the next calendar quarter.

Acknowledging that physicians in hospital-owned or large group practices may not have the luxury of opting out of Medicare, a good business case might be made for individual practices. There is some administrative burden in completing the opt-out affidavit and being sure that the Medicare contractor has validated it and then having each Medicare or Medicare Advantage patient sign a private contract every two years. But that effort should be more than offset by a reduction in many other administrative areas and an improvement to cash flow if a reasonable fee is set based upon actual costs per visit and perhaps a sliding scale for those patients with limited resources. If interested, you can try it out for 90 days and see if it works for your practice. There is a 90-day period after the effective date of the first opt-out affidavit during which physicians may revoke the opt-out and return to their prior status.

What do you think? If you are one of the few physicians who have opted out and still care for Medicare patients, how is it going? Are your patients able to receive equal or better access and quality of care? Do you miss dealing with CMS and their contractors?

Posted at 03:19PM Aug 17, 2011 by Cindy Hughes  |  Comments[0]

Four months left to ensure 5010 compliance: Are you ready to test?

We're entering the last month of summer and no doubt that means a plenty of students being rushed in for their school physicals and any necessary vaccinations. Before long, the students will be back in class and worrying about their next test. But they are not the only ones with tests to take. Your practice management or claims submission software vendor is being tested to ensure compliance with the 5010 HIPAA-compliant electronic transaction standards, and the Centers for Medicare & Medicaid Services (CMS) requires that they pass!

That is why CMS has announced a National 5010 Testing Week for Aug. 22 through Aug. 26. Practices whose software vendors have completed the necessary upgrades may take advantage of an opportunity to come together and test their work with the added benefit of real-time help desk support and direct and immediate access to the Medicare Administrative Contractors (MACs). This is a great opportunity to complete testing of the new transactions and move to production not only before the Jan. 1, 2012 compliance deadline but also before your practice must complete end-of-year tasks such as annual code updates and Medicare benefit changes for 2012.

If your software vendor or clearinghouse is handling the testing for you, be sure that you are aware of their progress and expected date of completion. The MACs will process both the current 4010 transactions and the 5010 transactions of those practices that have successfully tested. However, CMS has emphatically stated that on Jan. 1, 2012, only transactions in the 5010 format will be accepted. If you or your vendor have questions about testing or the formats for addresses or other claims fields, you can contact the Medicare Part B EDI helpline for assistance.

Don't let your claims submissions get an "F" on January 1st!

Posted at 12:13PM Aug 02, 2011 by Cindy Hughes  |  Comments[0]