HIPAA 5010

On September 14, 2011, in Medical Billing, Regulations, Software, by admin

GETTING READY FOR 5010 There really are benefits for you, the physician, in Version 5010.  It all seems like just another way to make the lives of the electronic medical world chaotic.  I mean face it, 4010 came around some 10 years ago and we are pretty comfortable with it, right?  However, there are some […]

GETTING READY FOR 5010

There really are benefits for you, the physician, in Version 5010.  It all seems like just another way to make the lives of the electronic medical world chaotic.  I mean face it, 4010 came around some 10 years ago and we are pretty comfortable with it, right?  However, there are some improvements…

System wide improvements within CMS simultaneously and implementing standard acknowledgement and rejection transactions across all jurisdictions.  Improving claims receipt, increasing consistency of claims editing and error handling and returning claims needing correction earlier rather than later.  Assigning claim numbers closer to the time of receipt is also an improvement.  These are just a few of the benefits to be improved upon in the electronic world related to your claims, remittances, eligibility and claims status requests and responses.

A few tips you may or may not know about yet…

  • A billing provider must be a provider of health care services not a billing service or clearinghouse.
  • Billing providers are entities that perform services and are reimbursed by health plans.
  • Make sure you are using the correct NPI for the organization.
  • The tax ID must be sent for the Billing Provider on the claim.
  • For health plans that assign a unique identifier per member, the individual must be listed as the subscriber.
  • The patient is not listed on the transaction.

For health plans that assign a number to the entire family, follow these rules:

  • The policyholder is always listed as the subscriber.
  • If the policyholder is the patient, the patient is not listed on the transaction.
  • If the dependent is the patient, they are listed as the patient in the transaction.

For professional claim transactions, 5010 requires total anesthesia minutes be reported.  In 4010, payers could require the anesthesia time be reported as the total number of minutes OR as units.  Units are no longer accepted for reporting anesthesia time.  Any requirements by a payer to submit anesthesia start and stop times in the 5010 transaction will be non compliant with the TR3.

Comments are closed.