Address claim issues before 5010 conversion

February 25, 2012

Questions include claim issues with 5010, RAC demand letters, and telehealth services. Find out the answers to pressing coding questions.

A: As you know, the Centers for Medicare and Medicaid Services (CMS) has given providers some additional time for 5010 claim submission, but I applaud you for meeting this challenge head-on now rather than later, because March 31 will be here quicker than you can blink.

If your clearinghouse continues to report claim submission issues, you should address this problem immediately to minimize the impact on your cash flow. First, check your Medicare carrier's Web site to see if your vendor is listed as 5010-approved. If it is not, call your vendor to see where it is in the approval process and when it expects to be 5010 compliant. Then hold it to that deadline.

If you are not receiving adequate answers from your vendor, if your vendor has yet to test, or if your vendor's testing continues to be unsuccessful, then you need to decide whether to move forward with this vendor. Contact your healthcare attorney for direction before making this decision.

RAC DEMAND LETTERS NOW ON CARRIER LETTERHEAD

Q: As the compliance officer for our physician group, I instructed our office managers to look for the recovery audit contractor (RAC) company logo on letters and then forward them to me as a part of our internal protocol so we can respond efficiently within the given timeframe. Is it true that the RAC letters now are going to be sent on the letterhead of our fiscal intermediary/carrier instead of the RAC's?

This change will require updated training for those involved in your internal RA protocol (for example, physicians, office managers, and billing staff).