Thank you to everyone who attended our latest webinar on February 15, 5010: The Good, the Bad, and the Ugly. Ken Bradley, Vice President of Strategic Planning at Navicure, led the one-hour event, which focused on how the new HIPAA 5010 electronic standard. During the webinar, he offered advice about:

• How to leverage 5010 to improve business processes.
• The most common 5010 errors and how to avoid them.

To learn more about how to leverage 5010 effectively so your revenue cycle remains healthy, click here to download this webinar.

This program meets AAPC guidelines for 1.0 Core A or 1.0 CPCO specialty CEUs. On Demand product requires successful completion of a Post-Test for continuing education units. Granting of prior approval in no way constitutes endorsement by AAPC of the program content or the program sponsor.

There are a number of laws and regulations your practice must strictly follow to ensure it is fully and accurately reimbursed for patient care services. These laws and regulations not only monitor payment accuracy, but are also in place to prevent fraud and abuse and to preserve patient privacy and security. If you don’t always comply with them, you risk your revenue cycle being impacted – or worse being fined. You simply can’t afford not to be in compliance.

The vast majority of physician practices strive to be compliant and can attest to the huge challenge behind the effort. This is because keeping up with the constantly changing laws and regulations, along with the updates to medical necessity, requires a significant amount of staff resources that many practices simply don’t have. It is not surprising that medical necessity almost always ranks among the top 10 causes of Medicare denial, especially given how frequently payer policies and National Correct Coding Initiative (NCCI) edits change.

Read More

More than ever before, practices must place greater focus on managing the revenue cycle process because of a tight economy and strict industry guidelines. With many imminent industry changes, such as ICD-10, it is important for every medical practice to implement specific processes to ensure their revenue cycle is not negatively impacted.

Nationally recognized revenue cycle expert Elizabeth Woodcock, MBA, FACMPE, CPC, has developed a seven step system that any practice can use to help redefine and manage revenue cycle efficiency. These steps include:

Read More

A few weeks ago, I spoke with the editor of ICD-10 Watch about how the transition to the new HIPAA 5010 electronic transaction standard went. Since the 5010 compliance deadline earlier this month, healthcare payers have had to learn to manage and respond to unexpected problems with medical claim rejections and denials. We discussed some of the specific problems that may be causing issues for practices, as well as the importance of tracking claims to ensure the reimbursement that practices receive is what they anticipated.

After our discussion, the editor wrote an article that summarized our discussion and the most common 5010-related problems practices are experiencing, along with the correction to these problems. You can read the full article here to learn more.

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 complimentary webinar, 5010: The Good, the Bad, and the Ugly. Register Now.

Read More

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.

Read More

It has been several 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.

Read More

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.

Read More

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.

Read More

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.

Read More