Wednesday, July 18, 2012
Steps to resolve version 5010 claims processing problems
Some physicians have reported claims processing problems that have resulted in payment delays following the Jan. 1 deadline to convert to the Health Insurance Portability and Accountability Act (HIPAA) version 5010 electronic transactions. Physicians who are still experiencing payment delays or other claims processing issues can take steps to resolve them.
The AMA has been working with the Centers for Medicare & Medicaid Services (CMS), state medical associations and individual physicians to help resolve claims processing issues that have arisen from the mandatory conversion to HIPAA version 5010. Physicians can complete an online form to report unresolved issues to the AMA or file a complaint directly with CMS.
Additional steps to take include the following:
- Physicians who use a billing service or clearinghouse should ask the vendor to explain why the problem is occurring.
- Physicians who submit claims directly to payers should ask them to identify whether there is a problem with the data they submitted or with the payer's system.
- Physicians who are experiencing problems with their practice management system should contact the vendor to resolve those issues.
The 120-day grace period for enforcement of HIPAA version 5010 expired two weeks ago, which means that non-compliant claims and other transactions will now be rejected. Visit the AMA's HIPAA version 5010 Web page for resources on becoming compliant.
CME activity helps doctors adopt preventive services
A new physician activity discusses the mechanics of implementing Medicare preventive services into the physician practice.
This online continuing medical education (CME) activity (free Medscape login required), a compendium of resources developed by Medscape in association with the AMA, the Centers for Medicare & Medicaid Services and the Centers for Disease Control and Prevention, helps physicians make the Initial Prevention Physical Examination and Annual Wellness Visit routine parts of their care for Medicare patients.
Featured materials include an archived AMA webinar on coding these services, video vignettes demonstrating clinician-patient communication strategies and answers to frequently asked questions.
Designed to help physicians form strategies for incorporating Medicare preventive services into their practice, the activity covers such key information as required components of each service, patient eligibility and co-payment information.