Medicare Fee For Service (FFS) 5010 Are you ready???

Slides:



Advertisements
Similar presentations
1 Medicare HIPAA Issues October, 2002 Kathy Simmons Centers for Medicare & Medicaid Services.
Advertisements

Medicare Fee For Service (FFS) 5010 and Testing. Purpose of Today’s Call Discuss readiness Transactions and errata Testing requirements and procedures.
1 Health Insurance Portability and Accountability Act of 1996 IS&C Expo October 16 & 17, 2002 John Wagner Governor’s Office of Technology.
What you need to know about billing to Medicaid Beverly Remm Director of Billing Orion Healthcare Technology.
Lesson 1 Overview of the 837 and Section 1: Overview Introduction How did we get to where we are now? What do electronic transactions mean to you.
February 9, 2012 HIPAA Version 5010 Update for PAG/TAG.
HIPAA Administrative Simplification Final Rule for Transactions Code Sets Stanley Nachimson
Presents: Weekly HIPAA Teleconference Revised
Medicare Fee For Service (FFS) 5010 and 837P. Purpose of Today’s Call Highlight differences Provide update on Medicare FFS activities Discuss Errata as.
Project Status January HIPAA 5010 CMS Updates CMS recently released a communication which outlined a “contigency” window for 5010 compliance.
Medicare Fee For Service (FFS) EDI ACT (August 9, 2012)
An Approach to 5010 My Experience Tim Bavosi, HRS.
Blair Elledge Quadax, Inc Discussion Topics Intended Purpose, Benefits, Why Change? 5010 Transactions…much more than claims Everyday Impact of.
MAC J5 and J8 EDI ACT (August 14, 2014) Participant Line: (800) Passcode:
HIPAA TRANSACTIONS HIPAA Summit IV 2002 UPDATE. HHS Office of General Counsel l Donna Eden l Office of the General Counsel l Department of Health and.
Medicare Fee For Service (FFS) EDI ACT (February 14, 2013)
5010 and ICD-10 Are you preparing?. Who are Covered Entities? Health care provider that conducts certain transactions in electronic format Clearinghouse.
MDCH HIPAA Transactions Provider Outreach David McLaury Director of Project Development and Implementation
Medicare Fee For Service (FFS) 5010 Moving Into Production.
Is Your Practice Ready for HIPAA Transactions, Code Sets and Testing? Mark Charles Consultant, Altarum David McLaury Director of Project Development and.
Home Health Billing What’s New With Medicare Billing Rules In 2013? May 6, 2013 F.O.R.C.E. Healthcare Resources, LLC (Founded on Regulatory Compliance.
Medicare Fee For Service (FFS) EDI ACT (June 13, 2013) Leader’s Line: Conference ID:
Billing Agent. Pre-Application Checklist Introduction to IMPACT and Key Terms Application Process Starting an Application The Business Process Wizard.
Rendering / Servicing Provider. Introduction to IMPACT and Key Terms Application Process Resuming an Application Starting a New Application The Business.
Washington Health Benefit Exchange C ARRIER T ESTING O VERVIEW & 834 DRAFT C OMPANION G UIDE R EVIEW February 27, :00-3:00 PM.
WHAT'S AHEAD? Kathy Whitmire Dale Gibson February 15, 2011 HIPAA 5010, ICD-10, ACO's, VBP, HIGLAS, PECOS.
June 12, 2015 ICD-10 Update for Maine Child Health Improvement Partnership (ME CHIP)
Medicare Fee For Service (FFS) EDI ACT (October 11, 2012)
ANSI 5010 Deidre Lawson Fryfogle- Product Manager.
MAC J5 and J8 EDI ACT (April 10, 2014) Participant Line: (800) Passcode:
MAC J5 and J8 EDI ACT (June 12, 2014) Participant Line: (800) Passcode:
Presented by Joan Kossow Data Compliance Manager The Changing Face of Claims Processing &
Medicare Fee For Service (FFS) EDI ACT (June 14, 2012)
MAC J5 and J8 EDI ACT (February 13, 2014) Participant Line: (800) Passcode:
Medicare Fee For Service (FFS) 5010 Troubleshooting with your contractor.
Medicare Fee For Service (FFS) 5010 Late Push For Late Implementers.
2014 Physician Quality Reporting System Webinar 2 – PQRS Ready To Start Claims Reporting Presented by: Marcy Le.
Medicare Fee For Service (FFS) 5010 and 837I. Purpose of Today’s Call Highlight significant differences between the 4010A1 837I and the I Provide.
MAC J5 and J8 EDI ACT (December 12, 2013). Purpose of Power Point Current issues MSP Claims 5010 ICD-10 Preparedness & Test Days Monitor Your Business.
National Provider Identifier: Implementation Issues Presented by Andrea S. Danes September 25, 2006.
Prepaid CCN Encounter Data April 18, 2011 Sharon Jackson Darlene White.
Facilitator: Kit Cairns, WIITTS 5010 Working Session It's Time to Get Techie.
HP Provider Relations October 2011 Medical Review Team.
Medicare Fee For Service (FFS) EDI ACT (August 8, 2013) Leader’s Line: Conference ID:
New York State Health Homes Implementation and Billing Update Statewide Webinar Presented by: New York State Department of Health January 12,
HIPAA TRANSACTIONS 2002 UPDATE. HHS Office of General Counsel l Donna Eden l Office of the General Counsel l Department of Health and Human Services.
The Language of HIPAA: Deciphering the Transactions and Code Sets By Scott Drinkard, MBA and Marion Munagian, RN, BSN.
Medicare Fee For Service (FFS) EDI ACT (October 10, 2013) Leader’s Line: Conference ID:
HIPAA Summit Audioconference Analysis of Addenda to HIPAA Transactions and Code Sets Rule Larry Watkins Executive Vice President, Claredi Co-chair, WEDI.
HP Enterprise Services HomeTown Health Presentation July 7, 2010 Partnering for Success!
CAHABA MAC Conversion MAY-09 Kathy Whitmire Dale Gibson Preparing for the Transition from an FI/Carrier to a Medicare Administrative Contractor (MAC)
RESEARCH AND RESOLVE Professional Claim Denials HP Provider Relations/June 2014.
Facilitators: Kit Cairns, Dean Health Greg Margrett, Netwerkes/Ingenix.
Segment 6: Provider Communication California ICD-10 Site Visit Training segments to assist the State of California with the ICD-10 Implementation June.
Standard Unique Health Identifier for Health Care Providers April 9, th Annual HIPAA Summit Gail Kocher Highmark.
ICD-10 Providers Information.  Expanded diagnosis and surgical procedure code sets to be much more specific  Expanded field format for ICD-10 codes.
Testing for Successful Deployment: Roundtable Discussion HIPAA COW Spring Conference April 8, 2011.
IHCP Updates HP Enterprise Services Provider Relations August 2010.
Welcome to WPS J8 Implementation - EDI Lisa Cuocci, EDI Sr. Analyst Med B JoEllen Fouts, EDI Sr. Analyst Med A.
October 2006 Web interChange - Basic Presentation Presented by the EDS Provider Field Consultants.
Medicare Fee For Service (FFS) EDI ACT (December 6, 2012)
The Coming Crash? HIPAA: Transactions, Codes Sets and Identifiers (TCI) Joseph C Nichols MD Paladin Data Systems Sept 16, 2003.
HIPAA Yesterday, Today and Tomorrow? Dianne S. Faup Office of HIPAA Standards Centers for Medicare & Medicaid Services.
Delaware Medical Group Management Association Meeting March 21,
Medicare Fee For Service (FFS) 5010 Moving Into Production - II (April 12, 2012)
Electronic Data Interchange (EDI)
Sherry Thomas, CCP, CCP-AS CEO/Director of Education
The Centers for Medicare & Medicaid Services
Are Stakeholders Prepared? Results from the WEDI Survey Conducted in
The Centers for Medicare & Medicaid Services
Presentation transcript:

Medicare Fee For Service (FFS) 5010 Are you ready???

Welcome and Purpose of Today’s Call Transactions and errata Testing requirements and procedures Know your readiness status Going into production

5010 Transactions and Affected Business Processes Claims (837 Institutional, Professional, COB, Dental, NCPDP) Claim Status (276/277) Claim Payment (835) Enrollment (834) Premium Payment (820) Eligibility (270/271) Referrals and Prior Authorizations (278) Claims Acknowledgements (277CA) Acknowledgement for Health Care Insurance (999)

Companion Guide To assist trading partners and their business associates with exchanging transactions Companion Guide provides technical and connectivity specification for the following: 837 Health Care Claim Institutional 837 Health Care Claim Professional 835 Health Care Claim Payment Advice 276/277 Status Inquiry and Response Companion guides posted to:

Timeline – 50 DAYS LEFT!!! Current contractor activities April 2011 through December 31, 2011 – Testing/Migration Must be 5010 Errata ONLY by January 2012!!! Last Day for 4010, December 30, 2011 before 4 pm cdst. Are you ready?

Compliance Date Compliance deadlines were set per federal rule CMS expects compliance deadlines to be met – no extensions Success will depend on starting early!

WPS is ready NOW! Are you? Testing began in January 2011 Submitters are in production NOW Test results returned within 3 business days when able 835 Production Parallel files available upon request by contacting the EDI Hotline. Results returned on a first come first served basis.

Are you prepared for 5010? Do you know your vendor’s schedule? Do you know your trading partner’s schedule? Has you vendor or clearinghouse tested and been approved? Have you tested and been approved? Have you moved into production?

Ready, Set, Go… Don’t Wait to test or go into production! Migration period ending soon, only 50 days left! Not just a Medicare issue – this affects all payers vendors and clearinghouses CMS fee for service does not anticipate any delays to compliance date CMS regulatory agency does no In order to receive the customer service and support you are accustomed to from your payers, vendors and clearinghouses it is important that you test early and go into production early.

If you choose to wait…

Direct Submitters Testing Procedures 25 claim minimum Testing in errata version only 100% syntax 95% Medicare business rules ISA14 highly recommended to = 1 ISA15 must = T Submitter is considered in test until approved by contractor

Testing FAQs Testing under your current sub ID Advanced registration is not required Know what needs to be changed Test what is applicable to you 5010 Top 10 Submission Errors Valid 9 digit zip codes in billing and facility loops.

More testing information January 1, 2012 – Compliance Date CMS does not anticipate extensions to this deadline. Test under your current submitter ID. Submitters are considered in test until approved by WPS. Consult with Software Vendor to confirm the 999 and 277CA will be returned in a human readable format! The timeline for testing the errata version begins now. Make sure your updates are scheduled before the compliance date. Dual submission of 4010A1 and 5010 errata claim transactions can be allowed. Submitters are generally expected to move into production within 30 days of approval.

Top 5010 Errors – Med A 837I Invalid codes DRG HCPCS Diagnosis Primary COB information missing COB out of balance Duplicate file Invalid NPI

Top 5010 Errors – Med B 837P COB data missing Billing provider physical address not used Billing provider not authorized for this submitter Invalid codes Zip (can not be padded with 0s or 9s) HCPCS NDC Rendering provider NPI same as Billing SV101-7 code description required for NOC/NOS codes.

Medicare Part A Statistics as of 10/22/11 thru 10/28/11 Contract# of Approved Submitters Percentage of 5010 Approved Submitters # Submitters Sending 5010 % of 5010 Claims Received J5 A 217/1, %988.8% Legacy A301/2, % %

Medicare Part B Statistics 10/21/11 thru 10/28/11 Contract# of Submitters Approved Percentage of 5010 Approved Submitters Submitter Sending 5010 % of 5010 Claims Received IL654/2, %2237.3% MI396/1, %1006.1% WI454/1, % % MN153/ %644.8% J5B864/4, % %

Getting 5010 – 835 Electronic Remittance Advice 835 Production Parallel files available upon request by contacting the EDI Hotline. Production 835 is generated based on how the receiver/provider are set up Not generated based on inbound claim format When ready, we can “flip” the entire submitter from 4010 to We can also “flip” on a provider by provider basis who gets Request to switch from 4010 to should be done in writing.

Getting 5010 – 276/277 Claim Status Inquiry and Response Testing is not required “Testing” is done using production data ISA14 highly recommended to = 1 Be sure to have ISA15 = P

Checklist for Moving Into Production Use the tools available to you to monitor your business Identify contingencies Read your 999 responses Read your 277CA responses Review your remittances Monitor your cash flow Identify and correct in a timely manner any issues identified.

How can I tell if I am 5010? Check your remittance advice. Part A Check 14 th digit of DCN = 7. Ex: Part B Check your ICN regions. RRYYJJJCCCCCC Ex: EMC 4010 EMC IL/IA MI/MO WI/KS MN/NE

PC-Ace Pro32 Providers may download PC-Ace Pro-32 software at the link below to submit 5010 file formats: This free 5010 errata software with instruction regarding set up posted on web site New PC-Ace users must test Existing PC-Ace users are not required to test.

Contingency Plans Approved vendor, billing services and clearinghouse lists: Readiness.shtml Readiness.shtml PC-Ace Pro32 Paper claim submission is not a contingency option Clearinghouse options? Set Up? Set Down? What are your contractual arrangements with vendor and/or clearinghouse? Other?

Lessons Learned Entities are slow to test Slow to move into production New EDI frontend was a good decision Early is never early enough Was 2.5 years enough time? Need to track submitters using an automated method Make no assumptions Improve Collaboration, Coordination & Communication Dual processing is a necessity Errata did not have any significant impact

Lessons Learned Continued… Make no assumptions Improve interpretations Standardize acknowledgments Develop a transition plan Improve Collaboration, Coordination & Communication Ability to change Allow dual processing Test early & often is necessary Move to production as early as possible Education Accountability Review X12 guides during comment period!

CMS National Provider Calls CMS will host a variety of national education calls that will inform the provider community of the steps that they need to take in order to be ready for implementation. These calls will also give participants an opportunity to ask questions of CMS subject matter experts Delivery of a series of National Provider Calls – presentations, transcripts and audio files available at Registration for upcoming events:

Future EDI ACTs 2012 These teleconferences are to address your EDI questions. No reservations are required. Who should attend? Providers, billing staff, vendors and clearinghouses with Medicare EDI questions calls (all times 1-2:30 pm cst): Date Dial In ID February 9, April 12, June 14, August 9, October 11, December 6,

Cutting Off 4010 Last 4010 inbound transactions accepted must be received and processed by WPS, before 4 pm cdst, December 30, transactions received after 4 pm will receive message that the format is no longer accepted. 835 receivers, who have not previously converted to 5010 will be switched.

Our Message to you… Move into production now! Work with your vendor and/or clearinghouse Know your vendor and clearinghouse schedule Office of HIPAA Standards announced compliance deadlines to be met – no extensions It is your responsibility to be compliant If you fail to prepare, it will be your business and cash flow that will be affected!

Questions and Answers We want to hear from you… Also visit our 5010 readiness site for additional FAQs:

EDI Addresses & Numbers Medicare Part A Legacy A Medicare J5 MAC Part A & B (multiple states)(Iowa, Kansas, Missouri, Nebraska)WPS Medicare EDI PO Box West Broadway Omaha, NE 68101Madison, WI Fax: (402) Fax: (608) Med A Hotline: (866) J5 Hotline: (866) Medicare Part B Legacy (Illinois, Michigan, Minnesota, Wisconsin) WPS Medicare Electronic Data Services 912 N Pentecost Drive Marion, IL Fax : (618) Med B EDI Hotline:(877)

Resources CMS 5010 and D.0 Webpage Educational Resources: Technical Review Type 3 guides: X12: Washington Publishing WPS 5010: CMS National Provider Calls: