HIPAA Version 5010 Issues Impacting Client Cash Flow
By Bellinger P. Moody, RHIA, CPC, CPC-I, CCP
Executive Vice President of Compliance

2/2/2012

There are a number of 5010 issues that are impacting client cash flow, many of which are beyond Medac’s control. The issues are as follows:

1. Due to the uncertainty of 2012 payment schedule CMS had a moratorium on processing 2012 dates of service for the first ten days of January. Now, all Medicare claims are filed and processed electronically, so the cash flow lag associated with this issue should recover quickly.
2. The new 5010 claims specs are creating difficulties in a number of areas. We are working through specific issues with a number of carriers but even when there are no specific issues, we have noticed a general slowdown in processing with certain insurance companies.
3. Also related to 5010, Medicare stopped sending Response Notices at the end of December. When we follow up on unpaid claims, we are being informed that there is no claim on file. Rather than wait for a resolution, we have re-filed all unpaid claims.
4. We have recently uncovered another 5010 error. A number of carriers that still process paper claims (mostly Workers Comp and Commercial) are sending payments to the facility. We are working with our clearinghouse to resolve this problem. In the meantime, the facilities should be alerted that they may be receiving checks that belong to your group.
5. Lastly, claims are subject to deductibles at the beginning of each year. In the past, this was primarily Medicare. Now, there are plans with high deductibles (even with in network services) that are the patients’ responsibility. As you know, it always takes longer to collect from the patients.

This is a national issue as evidenced by a recent letter from MGMA to HHS regarding payment disruptions caused by HIPAA Version 5010 implementation. Medac will keep you apprised of this situation as these issues are resolved. If you have any further questions, or wish to discuss in greater detail, please contact your Medac Practice Management representative.

The information presented herein reflects general information that is current as of the date it was first published. In light of changes that may occur in the health care regulatory and compliance environments, the author's presentation of this information might become outdated. Please check with your individual legal and/or compliance advisor(s) prior to taking any significant actions based upon the information and advice presented.