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5010 “Ready or Not”. Lakeland Regional Medical Center Tips and FAQ’s. Timeline. As of 11/11/11, there are 39 days left Medicare live 10/01/2011 – returning remits available as well in 5010 Florida Medicaid live 10/01/2011 – returning remits available as well in 5010

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5010 ready or not

5010 “Ready or Not”

Lakeland Regional Medical Center

Tips and FAQ’s

timeline
Timeline
  • As of 11/11/11, there are 39 days left
  • Medicare live 10/01/2011 – returning remits available as well in 5010
  • Florida Medicaid live 10/01/2011 – returning remits available as well in 5010
  • Big 5 commercial payers live by 12/01/11 – Including Blue Cross, United Health Care, Humana, Aetna and Cigna
gap analysis results
Gap Analysis results
  • Field by field comparison from current 4010A1 format to 5010
  • Performed in 2009 in preparation
  • Several new segments or loops
    • HIS systems may still be coded to require entry on registration
  • BEWARE of deleted segments or loops
    • If deleted segments or loops are passed in productions claims, the claims have been proven to fail
    • Double check with billing scrubber and clearinghouse
frequent errors
Frequent errors
  • Feedback from Siemens user groups
    • Small percentage of Florida Medicaid claims getting through
      • Usually secondary physician ID related
    • Medicare claims seem to be accepted initially but large percentages are going into RTP
      • Feedback suggests these are based around the removed Pay to Provider segment (see Gap Analysis)
      • Feedback also suggests that there are many POA errors
  • Feedback from Relay Health
    • List serve documentation as it is assembled
    • 5010 site available and updated weekly
faq s
FAQ’s
  • What can I expect from this conversion?
  • What effect can it have on my cash flow?
  • What are the major issues with testing?
  • What kind of test results are being revealed?
what can i expect from this conversion
What can I expect from this conversion?
  • PFS/IT departments will work to make it as invisible and painless as possible
  • However, ensure adequate resources are allocated to shoring up changes in bill scrubber and follow up with payers for errors
  • Intensive processing scrutiny from Medicare, Medicaid and Big 5 payers – expect rebills
  • Expect to allocate staff in the short term to compensate for the detailed research when claims are returned or rejected
  • Expect payment delays
what effect can it have on my cash flow
What effect can it have on my cash flow?
  • As with any billing change, this has the potential for huge impact
    • If not properly addressed - days or even weeks of cash delays
  • Ensure that claims are properly translated or submitted via bill scrubbers to avoid rejections
  • Faster follow up claims turnover and rebilling will greatly reduce the impact
  • Watch error reports
  • Everyone is going through this together – there will be issues
what are major issues with testing
What are major issues with testing?
  • User group feedback suggests that there are still major billing scrubbers applying 4010A1 edits to new 5010 claims
  • It is imperative that the payer testing be completed with properly translated or imported claims
    • Not a 4010A1 with the new 5010 fields
    • Not a 4010A1 with 5010 headers and footers
  • Physician ID issues
    • ONLY NPI numbers are now being accepted – HIS updates may be necessary if not all are collected
what kind of test results are being revealed
What kind of test results are being revealed?
  • User group feedback indicates that Pay to Provider and Secondary Physician (Non-NPI) ID’s are the biggest problems
  • Relay Health information indicates:
    • NPI issues
      • Separately enumerated subparts must be reported as the correct billing provider
      • Individual provider NPI’s are required (physician)
    • COB Balancing
      • Must indicate how much other payer paid AND patient responsibility/amount due
    • Admit date – Inpatient ONLY
test results cont
Test results (cont.)
  • Relay Health also indicates:
    • NDC Drug quantity
      • If NDC present, then QTY required
    • Patient Reason for visit
      • Required for outpatients
      • Will reject if not appropriate for revenue code bill type combinations
summary be ready
Summary: …Be ready
  • Don’t assume this will be invisible
  • Allocate staff
  • Prepare to touch claims several times before acceptance
  • Watch rejection reports
    • Payers are going to have issues too, and may erroneously reject your claims
  • Work closely with billing vendor and clearinghouse
  • Properly prepared billing and follow up team can greatly reduce cash flow impact