HIPAA 5010 Problems Abound

The original HIPAA Version 5010 deadline of January 1, 2012 has come and gone. Of course by now we all know (or at least should know!) that they now settled on a deadline of June 30, 2012. Actually, they didn’t move the deadline. The CMS enacted an enforcement discretion period thru June 30th for all covered entities. But what does all of this really mean to the billing staff?

Whether you are a billing service, or the billing staff in a provider’s office, it is important that you know what 5010 is and if you are compliant. If you are not yet compliant you really need to kick it into high gear. Most of us are for the most part are compliant but we are just experiencing little ‘hick-ups’ from the conversion. And many of these hick-ups are at our clearinghouse or at the insurance carriers’ end.

I would like to say that I am shocked to hear that some are still not even aware of 5010 let alone compliant but unfortunately I’m not. There are a lot of offices that either think that the memos don’t pertain to them, or they just don’t have the time to look into what the memos are saying.

We get a lot of questions on our forum that are 5010 related. One of the common ones are people receiving rejections due to the address in the pay to field. Per 5010 that address can no longer be a PO Box. Even people who are 5010 compliant don’t realize all of the stipulations in the format.

If you receive a rejection that you are unfamiliar with it may very likely be due to 5010. If the rejection is a clearinghouse rejection, call your clearing house and ask them to explain the rejection. It may be something on their end or the insurance carriers end but they should be able to help you. If the rejection is directly from the insurance carrier, call them. Again, if it is a mistake on their end they should be able to fix it. If it’s not a mistake they should be able to explain it to you.

I received an email from a Medicare contractor that said something like “Top 5010 Questions Answered By …” It was such a joke. It didn’t really tell us anything. Basically, if you are not sure yet or if you know you are not, 5010 compliant, you need to take action immediately. Start by contacting your software vendor to see what you need to do. If you are all set with your software check with your clearinghouse, As far as I know all clearinghouses are now submitting using the 5010 format but you should make sure your claims are uploading to them ok and that they are submitting in 5010 ok.

Don’t keep waiting to see what will happen. Your (or your provider’s) payments will be interrupted and it will create a mess for you. There is still time to get compliant. Don’t put it off any longer.

New Web Based Mental Health Billing Software

In the world of medical billing where changes are frequent, we are always looking for newer and better ways of doing things. Recently we found an exciting new concept in a practice management system for mental health professionals called Empathic. This web based program was developed by a therapist to meet all the needs of the therapist. We found it to be very impressive. Even better, the creator of this software is currently working on developing it for other specialties. The costs are reasonable and we are closely watching as this company expands. You can check out this company at Empathic

Answers to Your Medical Billing Questions

All of us find ourselves in need of answers to questions that arise in medical billing and we’ve provided you with a place to get those answers. Our medical billing forum is visited daily by many expert medical billers who are happy to share their knowledge and experience. We often come up with questions ourselves and find that the forum is a wonderful place to get help and advice.

How to Handle Problem Claims

One of the things that differentiates a good biller from an average biller is their ability to get to the bottom of a problem claim. To some of you, this may seem like a no brainer. That’s a good sign. You assume it’s a given to be able to get to the bottom of a problem claim. But unfortunately it’s not always a given.

Some billers do not take the time to get to the bottom of the problem claims; they just mark them as uncollectable or bill the patient. Some do this because they don’t want to be bothered or take the time necessary to deal with the issue; others do it because they simply do not know how to get to the bottom of it.

These problem claims can add up and if not handled could cost a provider a lot of money at the end of the year. Many times the provider isn’t aware that these claims exist let alone know if their biller is handling them or not, but they should.

Problem claims do not have to be such a headache. They just need to be dissected and the necessary action needs to be identified. First, start by deciding if the claim was handled properly by the insurance carrier. If you do not believe the claim was processed correctly you should start with a phone call to the insurance carrier. Sometimes these things can be cleared up with a simple phone call. Even if the issue cannot be resolved with the phone call, the customer service representative should be able to tell you what action needs to be taken.

If you have a claim that you are unsure of why the claim was processed the way it was, call the insurance carrier and ask them to explain it to you. They should be willing to go thru the claim and explain why they did what they did. If you do not agree with the explanation you can appeal the claim. Just make sure you attach any documentation that you have to support your position. The more documentation you supply the better your chances are. Remember sometimes things are processed a certain way because of the plan provisions and no matter how much documentation you attach the decision will be upheld.

A claim may seem like it is a huge problem but in reality it is usually just that you need to identify the problem and determine what action you need to take. Don’t let a problem claim intimidate you into just writing it off. Make sure you determine if it is truly a service that you cannot be reimbursed for, if the insurance carrier made a mistake, or if the patient is responsible and then handle it accordingly.