1. ICD-10: It’s Closer Than It Seems – Steps to Take to Refine your
Version 5010 Upgrade
The Version 5010 upgrade deadline was Sun Jan 1. CMS initiated an enforcement
discretion period for 90 days, which ends on Sat Mar 31. You should be
finalizing your upgrade to Version 5010 if you have not yet done so.
Once you have finished your upgrade to Version 5010, you'll need to ensure your
system continues to run properly. Providers should look for the following
indicators to make sure there are no problems with their system upgrade:
• An Increase in Rejections or Denials of Claims – An increase in rejections
or denials of claims may be an indication that there is not sufficient or
correct data provided to meet Version 5010 standards. Partners, such as
payers, also have a part in correcting this issue, since forwarding,
converting, or formatting data can result in rejections or denials. Monitor
your claims closely to determine the reasons for rejection or denial of claims
and coordinate with payers to ensure that data is properly processed to avoid
claim delays.
• Issues with Non-Electronic Funds Transfer (non-EFT) Payments – Version 5010
includes changes to claims formatting, including a full nine-digit zipcode and
inclusion of provider billing address. Submitting claims with only a
five-digit zipcode will result in rejection. If your practice has not
submitted the correct billing or mailing address as part of your Version 5010
claim, your non-EFT payments or Explanation of Benefits (EOBs) information may
be mailed to the wrong physical location. Make sure to coordinate with your
payers to verify how they use enrollment information and process claims data,
as this will also be affected by the mailing address on file. Being diligent
in tracking your claims and remittances (EOBs) will help identify and address
any issues that may arise.
• Formatting Discrepancies with Partners – Your trading partners should also
have upgraded to Version 5010; however, your organization may interpret the new
standards differently than your external partners, which can result in rejected
claims. You should coordinate with your payers and/or clearinghouse to
determine any gaps or discrepancies in claims submissions. You and your
partners should monitor claims that are automatically transferred between
payers and address new response formats or data as claims are processed.
Make sure to take a look at the Version 5010
section<https://www.cms.gov/ICD10/11a_Version_5010.asp> of the ICD-10 website
to find helpful factsheets on the upgrade to Version 5010 and previous listserv
messages discussing the Version 5010 upgrade.
Keep Up to Date on Version 5010 and ICD-10. Please visit the ICD-10
website<http://www.cms.gov/ICD10/> for the latest news and resources to help
you prepare, and to download and share the implementation
widget<http://www.browserspring.com/widgets/cms2/iframe.html> today!
2. Important Update – “HIPAA Version 5010/D.0 Implementation” Document has
been Updated
Updates have been made to the recently-posted document titled “Important Update
Regarding HIPAA Version 5010/D.0 Implementation” – specifically, CMS has
modified information related to the Diagnosis Related Group (DRG) code. The
document can be found at the top of the HIPAA Versions 5010 & D.0 Overview
webpage, at http://www.CMS.gov/versions5010andd0/01_overview.asp.
________________________________
It’s Not too Late to Give and Get the Flu Vaccine. Take advantage of each
office visit and protect your patients against the seasonal flu. Medicare will
continue to pay for the seasonal flu vaccine and its administration for all
Medicare beneficiaries through the entire flu season. The Centers for Disease
Control and Prevention (CDC) also recommends that patients, healthcare workers
and caregivers be vaccinated against the seasonal flu. Protect your patients.
Protect your family. Protect yourself. Get the Flu Vaccine—Not the Flu.
Remember – The flu vaccine plus its administration are covered Part B benefits.
CMS has posted the 2011-2012 seasonal flu vaccine payment limits at
http://www.CMS.gov/McrPartBDrugAvgSalesPrice/10_VaccinesPricing.asp. Note that
the flu vaccine is NOT a Part D-covered drug.
For more information on coverage and billing of the flu vaccine and its
administration, as well as related educational provider resources, visit
http://www.CMS.gov/MLNProducts/35_PreventiveServices.asp and
http://www.cms.gov/immunizations.
________________________________
Note: If you have problems accessing any hyperlink in this message, please
copy and paste the URL into your Internet browser.
If you know someone who would like to subscribe to a Medicare Fee-For-Service
(FFS) provider listserv, go to
(http://www.cms.gov/prospmedicarefeesvcpmtgen/downloads/Provider_Listservs.pdf).
If you would like to unsubscribe from a specific provider listserv, please go
to (https://list.nih.gov/cgi-bin/wa.exe?INDEX) to unsubscribe or to leave the
appropriate listserv.
Please DO NOT respond to this email. This email is a service of CMS and routed
through an electronic mail server to communicate Medicare policy and
operational changes and/or updates. Responses to this email are not routed to
CMS personnel. Inquiries may be sent by going to
(http://www.cms.gov/ContactCMS). Thank you.
