Tag Archives: 5010

5010 Tip #5

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!

5010 Tip #4

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 thatContinue Reading

5010 Tip #3

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 thatContinue Reading

5010 Tip #2

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 thatContinue Reading

AAPC 5010 Survey Results

The AAPC did a survey last week, which I participated in for each of my clients.  I let you all know about it in this post.  The results were released today and if you are interested, click this link and you can review the data.  It is interesting if you care to know what everyoneContinue Reading

Letter from a Provider: Dear Center for Medicare and Medicaid Services

An Oklahoma provider was the first to receive EHR Incentive Program funds from Medicaid.  She shares her story here on a letter she would write to Medicare and Medicaid Services if she could as follows: Dear Center for Medicare and Medicaid Services.  She would send it, if they would listen.  If they cared.  It is worth reading.Continue Reading

5010 Tip #1

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 thatContinue Reading

CMS Important Update regarding 5010

With the implementation of Accredited Standards Committee (ASC) X12 Version 5010, several concerns have been identified that may impact certain activities surrounding the transition.  Medicare has published a Guidance and Clarification for Version 5010 Implementations here.

5010 Nightmare

I have been in the Medical Industry for 16 years and I have seen changes over time affect our industry and create problems of such a major impact that you have issues that are referred to as a Nightmare.  Nightmares both literally and figuratively.  Horrific nightmares that all of us dread and seriously hope weContinue Reading

Top 5010 Issues

Many physician practices have reported numerous problems across various areas of the United States stemming from the transition to Version 5010. The most frequently reported problems have involved: Issues with practice management and/or billing systems that showed no problems during the testing phase with their MAC, but once the practice moved into production phase, foundContinue Reading