5010 Constraints… Many Practices have Lower Payments for January.

February 3, 2012

As you know, the formatting for electronic claims submission changed effective January 1, 2012. The change required additional required fields and updated programming for vendors and information technology gurus. That date has come and gone… and there are issues.

While CMS is up and running relatively smoothly, there are many carriers and clearinghouses that continue to have trouble accepting the new format. CMS was smart about this change: they began ‘testing’ files with vendors during Q4 2011 and approved only those vendors whose updates met the new standards. It appears that most are submitting electronically to CMS with little to no difficulty. Commercial clearinghouses, the Blues, and direct carriers appear to be the culprits of the unpreparedness we are currently facing with the electronic submission changes.  Maybe they thought that the change wouldn’t happen or the deadline would be delayed. Either way – that didn’t happen and now they’re scrambling….

If your cash is down this month, circle back to the very beginning of the electronic billing process: the electronic submission.

1.       Is your vendor (billing agent, software, clearinghouse) up and running?

2.       Have they tested their files and been approved?

3.       Are they watching for file acceptance or rejection?

Remember that the absolute deadline for 5010 formatting is March 31, 2012. If the programming is not completed and accepted by that date, your cash will stop completely.

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