Monthly Archives: January 2012

5010 Review

The healthcare industry has been using HIPAA 5010 standards to transmit electronic medical claims for a few weeks. How’s that working for your practice?  Are you seeing denials?  Do you know what to be looking for and get the data fixed?  While it’s tempting to assume that no news is good news, a lack of response doesn’t mean there is not an issue.  Make sure you watch out for any medical claim rejections and denials and fix them as quickly as possible. Some of the problems that could be causing rejections or denials includes:

  • National Provider Identifiers (NPI) need to be used, not an employer’s tax ID or Social Security number.
  • HIPAA 5010 requires that a street address – not PO Box, be used on all medical claims.
  • Providers can use a PO Box for a billing address that receives reimbursement checks. But make sure the payers have that on file and are using it.
  • Speaking of addresses, providers need a nine-digit zip code with the billing and physical addresses.
  • HIPAA 5010 allows as many as 12 diagnosis codes on each claim, but each specific service can only have four codes.
  • Any claim using an unlisted Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) code also needs a code description.
  • Healthcare providers must submit a Medicare Secondary Payer (MSP) indicator on the primary and secondary claim when Medicare is the secondary payer.
  • Drug quantity and unit of measurement are required when a National Drug Code (NDC) is listed.
  • All ingredients in a compound prescription must be listed with a HCPCS code.

In addition to watching the number of denials or rejections, make sure the reimbursements match what you expect. Just because the claims get out the door, doesn’t mean they it will be processed correctly for reimbursement.  There are many aspects to the claim process and all must be evaluated.

We hope you are having  success with the transition from 4010 to 5010!

Quotes

Outstanding leaders go out of the way to boost the self-esteem of their personnel. If people believe in themselves, it’s amazing what they can accomplish. – John Quincy Adams

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Be a professional at whatever you do, and you’ll reap the benefits for a lifetime. – Glenn Shepard

Year End and IRS Forms

Year End comes every 365 days.  For many, it sneaks upon them very quickly each and every year.  Many people don’t plan ahead for tax time, yet if you are diligent and do the necessary steps in bite size chunks, tax time will not be a nightmare for you.  In order to evade the nightmare,Continue Reading

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Leadership is the capacity to translate vision into reality. – Warren G. Bennis

new definition for 5010

I want a new definition for 5010. Is it Fifty Ten…or is it Five o One o? Wonder what its true meaning will be? Five months of hell?  One month of revenue? Five times as long to complete one task? Five steps back one step forward? I need some humor to make it through theContinue Reading

Medical Necessity means just what?

When an Insurance Carrier processes a claim and denies for this does not meet Medical Necessity, what do they mean by that? The term “Medically Necessary” or “Medical Necessity” is defined as a health care services that a Provider, exercising prudent clinical judgment, would provide to a patient for the purpose of evaluating, diagnosing orContinue Reading

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Failure is not fatal, but failure to change might be. – John Wooden

Keys to Achieving Your Goals

Another year and another set of resolutions. If you’re like most Americans, you’ll probably forget your goals by mid-February. So how do you make your resolutions actually happen this year? First, keep in mind that goals are dreams; but don’t stop at just dreaming. Turn your dreams into bite-sized pieces that will gradually create aContinue Reading

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The quality of a person’s life is in direct proportion to their commitment to excellence, regardless of their chosen field of endeavor. – Vincent T. Lombardi