On January 1, 2012 HIPAA 5010 became the new required standard for electronic transactions. Are you wondering how to leverage the new 5010 standard effectively while ensuring your revenue cycle remains healthy?

Join us on Wednesday, February 15^th at 1:00 pm EST, for a complementary webinar, 5010: The Good, the Bad, and the Ugly. Register Now.

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The month of January presents opportunities to not only consider the year ahead, but also look back at the year just passed. With this in mind, we wanted to take a look at our most popular blogs from 2011. As you’ll see, most of them merit revisiting as your practice plans for the future.

• HIPAA 5010 – Understanding Two Important New Requirements. This blog focuses on two changes medical practices must make to their claims submission process to be 5010 compliant: using a physical address as the provider billing address and incorporating nine-digit ZIP codes into billing provider and service facility addresses. While many practices have made these changes, we’re finding that some still need to do so. It’s important to note that technology vendors cannot make these changes for practices; practices must make them on their own.

• How Paper Claims Will Be Impacted by 5010. This blog clears up some confusion that still exists today about how 5010 affects paper-based claims. While most providers filing claims with Medicare and other payers need to be compliant with 5010, those providers or payers who meet certain exceptions to the HIPAA requirements and still file on paper aren’t subject to 5010 requirements. If you’re among those providers, you can continue filing paper claims as always—at least for now.

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It has been over two full weeks since HIPAA 5010 became the required electronic transaction standard, and by now many practices are beginning to see how the many changes are impacting claim rejections. For the past couple of weeks, I have been monitoring trends in claim rejections—specifically looking at ones that are directly related to 5010. As can be expected, there has been an uptick in a number of rejections. Within all of these rejections, five specific ones caught my eye because each one could easily be corrected so practices can avoid such rejections in the future. Here is a quick look at these five rejections and how to prevent them:

1. No Medicare Secondary Payer (MSP) reason code on a primary claim. In Version 4010, claims only required MSP on secondary claims submitted directly to Medicare. Now, however, healthcare providers must submit an MSP indicator on both the primary and secondary claim when Medicare is reported as the secondary payer. If this information is not included, the claim will be rejected.

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The New Year always brings new challenges for healthcare organizations, and 2012 is no exception. Case-in-point: The transition to 5010 is already testing the financial health of practices—and that only took effect on January 1.

While much of the 5010 transition seems to have progressed smoothly, it’s imperative that practices across the nation carefully monitor their cash flow and bottom line throughout the year to make sure that this trend continues. Spikes in rejections and denials, for instance, can be the first warning signs of problems—and may or may not be related to the 5010 transition.

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Thank you to everyone who attended our latest webinar on January 5, Reimbursement Reality 2012: The Challenges – and Opportunities – for Medical Practices. Nationally recognized revenue cycle expert and author Elizabeth Woodcock, MBA, FACMPE, CPC, led the one-hour event, which focused on the challenges and opportunities reimbursement and payment programs offer for medical practices in 2012. During the webinar, she offered advice about how to:

• Leverage the key changes in 2012
• Manage the increase in patient financial security
• Successfully participate in the government’s incentive payment programs

To learn more about how your practice can stay as profitable as possible in 2012, click here  to download this webinar.

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It may seem unbelievable, but after many months of reading about it and preparing for it – 5010 is finally here. This past Monday, members of billing staffs around the nation needed to ensure that payers received claims using Version 5010 of the electronic transaction standards. Even though most practices have tested the new format and worked with vendors to ensure everything is in order, Monday marked the official date 5010 will be in full effect and the hours of preparation will pay off.

It cannot be denied that the long-term benefits of Version 5010 will help the entire industry become more standardized and will negate many variables in claims submission. After all, the main purpose of 5010 is to standardize the data content in all claims for all payers in healthcare. Over the next few months, as payers and practices begin to leverage the new system, all healthcare organizations are sure to realize 5010′s true benefits.

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The words “RAC audit” can strike fear in any medical practice. These audits are the process through which recovery audit contractors (RACs) review Medicare claims to identify improper payments, including overpayments and underpayments. Although these audits have been occurring for awhile, most practices still find them challenging to navigate. And, in just a few days—January 1, 2012, to be exact—the Medicaid RAC program will take effect. That means RACs will start reviewing Medicaid claims as well.

There are two ways RACs typically identify overpayments. The first takes an automated approach where the contractor uses proprietary software to find unambiguous instances of overpayment. This approach doesn’t include a medical record request.

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Almost every industry article written today about revenue cycle focuses on how to streamline and improve the process. Although there are a lot of ways to streamline a practice’s revenue cycle, in my practice experience, I found that consistently implementing three key activities can help enhance staff workflow, reduce claim denials, and ultimately improve a practice’s bottom line.

The first of these activities is verifying insurance. While this may seem like a self-evident step, many practices neglect to perform this critical task—and for understandable reasons. Many practices simply don’t have the staff resources for what too often is still a manual chore. If they do perform it, practices often wait until the patient is standing at the front desk.

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As an industry, the transition to HIPAA 5010 has been a learning opportunity – especially showing the benefits of planning and questioning a vendor’s capabilities early on. These lessons can be taken and applied to the next big transition – ICD-10, which will be the required coding set starting on October 1, 2013. Many people in the industry believe that there is plenty of time before the transition, and that they can start the transition process at a later time. However, now is the time for practices to start preparing for the coding change. So when I was recently given the opportunity to speak with a writer from For the Record about how the transition to ICD-10 would impact the industry and how practices should prepare, I was happy to share my thoughts.

At the start of this conversation, we focused on how this transition would impact everyone in the healthcare industry. It was the coders, though, that quickly became the focal point of our discussion. Specifically, we talked about the types of questions coders should be asking when preparing an ICD-10 transition plan. These questions include:

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In today’s economic environment, the timely collection of all earned revenue is not a luxury—it’s a necessity. That’s true for all practices – not just specialty ones. At Regional Urology Enterprise, for example, I’ve had to navigate the revenue pitfalls associated with imaging and radiation treatments. What I’ve learned, though, is practices that leverage technology to improve efficiency, streamline workflow, and proactively identify and respond to systemic issues can ensure they collect all the money they earn.

I consider my practice’s automated clearinghouse as one example of technology that kills two birds with one stone: it improves our overall performance while it also enhances the bottom line. We use it in a variety ways, but most notably to:

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