You went to an EMR/EHR in preparation for the regulation changes in the Healthcare Industry for 2014 and to avoid a deduction in Medicare Claims Payment. That was a huge financial cost to your practice and the last thing you anticipated was having a cash flow crisis to the industry electronic claim file changes that CMS ruled would take place January 1st, 2012. I know. Remember, like you, I am experiencing the 5010 fiasco I blogged about here with my clients, so I totally relate to your pain. However, I hope by now you are making great strides in the conversion. If not, I am sorry. I wish I could fix it with a magic wand, however, I can’t. I can provide you a few pieces of information that might help you get some cash flow turnaround quickly and will be posting a few tips on Version 5010 that will provide you some resources to help you make headway through to get some answers to your problems.
The deadline was set for enforcement of Version 5010 on March, 31, 2012…however last week CMS released an update that this has been extended to June 30, 2012. However, we recommend that if you have not begun to convert to the Version 5010 format, you should start today and be finalizing your upgrade this week because there is no reason to put it off. Once you have finished your upgrade to Version 5010, you’ll need to ensure your system continues to run properly. Providers should look for the following indicators to make sure there are no problems with their system upgrade:
An Increase in Rejections or Denials of Claims
An increase in rejections or denials of claims may be an indication that there is not sufficient or correct data provided to meet Version 5010 standards. Partners, such as payers, also have a part in correcting this issue, since forwarding, converting, or formatting data can result in rejections or denials. Monitor your claims closely to determine the reasons for rejection or denial of claims and coordinate with payers to ensure that data is properly processed to avoid claim delays.
Issues with Non-Electronic Funds Transfer (non-EFT) Payments
Version 5010 includes changes to claims formatting, including a full nine-digit ZIP code and inclusion of provider billing address. Submitting claims with only a five-digit zip code will result in rejection. If your practice has not submitted the correct billing or mailing address as part of your Version 5010 claim, your non-Electronic Funds Transfer (non-EFT) payments or Explanation of Benefits (EOBs) information may be mailed to the wrong physical location. Make sure to coordinate with your payers to verify how they use enrollment information and process claims data, as this will also be affected by the mailing address on file. Being diligent in tracking your claims and remittances (EOBs) will help identify and address any issues that may arise.
Formatting Discrepancies with Partners
Your trading partners should also have upgraded to Version 5010; however, your organization may interpret the new standards differently than your external partners, which can result in rejected claims. You should coordinate with your payers and/or clearinghouse to determine any gaps or discrepancies in claims submissions. You and your partners should monitor claims that are automatically transferred between payers and address new response formats or data as claims are processed.
Read the information on the Version 5010 section of the CMS website to find helpful fact sheets on the upgrade to Version 5010 and previous listserv messages discussing the Version 5010 upgrade.
Come back next week for another 5010 Tip!