Some Interesting… and Disturbing… Results
by Cheryl Nash
As you may be aware, electronic claim formats have been switched from an older 4010 format to a newer 5010 format. The new format was to be implemented on January 1, 2012 to be ICD-10 compliant prior to mandatory use in October of 2013. Live sending commenced after the first of this year.
What this Means to You: This has caused many unforeseen electronic claim responses. We have seen and heard reports of multiple erroneous claim rejections in the past month, such as claims being rejected for no patient insurance identification number, no Tax ID number, and no referring provider just to name a couple. Of course all of this information has been on the claims, but the rejections are caused by clearinghouses not being able to read, or payers not able to receive, this data. The mistakes are random, and are seen nationwide, across all payers and clearinghouses, and are causing some delays in claim submission and processing. This ultimately causes delays in payment to the providers as well.
How to Correct: A timely response to the clearinghouse to report erroneous rejections as soon as they are seen is the best action. Most rejections are addressed by the clearinghouse, and the claim re-sent with no further action on your part. However, if no solution can be found quickly, we recommend contacting the payer to see about a desired alternative way to submit claims. Fax is the next best submission format after e-claims, as it generates a tangible proof of timely filing, and paper is a last resort, but of course there are some payers (like Medicare) who will not accept claims in fax or paper fashion. Check with the insurance payers to be sure the format will be accepted!
*** Update to ICD-10- CMS has released this update to the ICD-10 implementation date as a response to feedback from providers and agencies nationwide such as the AMA lobbying for a delay to the Oct. 2013 effective date.
Marilyn Tavenner, acting CMS administrator, told a conference of the American Medical Association today that CMS may “re-examine the pace at which we implement ICD-10,” .
All HIPAA-covered healthcare providers must transition from ICD-9 to ICD-10 by Oct. 1, 2013. Although Ms. Tavenner did not say if there would be an actual delay, she said CMS would create new regulations over the coming days.
“There’s concern that folks can’t get their work done around [adoption of health information technology], their work done around ICD-10 implementation and be ready for [the health law’s insurance] exchange,” Ms. Tavenner said in the report. “So we’re trying to listen to that and be responsive.”
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