5010 troubles some

Thursday, January 26, 2012

YARMOUTH, Maine - The transition to HIPAA version 5010 on Jan. 1 has been fairly smooth for Medicare, but there have been bumps in the road for commercial payers, resulting in delayed payments to home medical equipment providers, industry sources say.

Even if HME providers and their software vendors are up to speed with 5010, when they send their claims to commercial payers that haven't made the transition yet, those claims are getting rejected by clearinghouses, sources say.

"This has been my biggest priority since Jan. 1," said Sylvia Toscano, owner of Professional Medical Administrators, a billing and consulting firm in Boca Raton, Fla. "In general, I don't think anyone has been fully prepared for this, and the call volumes at the clearinghouses have been three times higher than they usually are, but everyone is working together."

Although Jan. 1 was the implementation date for 5010, a new standard for electronic claims submission, for Medicare, at least, there's a grace period until March 1.

For the time being, when payers aren't ready to receive claims in 5010, most clearinghouses are able to translate them back to 4010, but that often opens the door for mismatches and other errors, sources say.

"We'll be better off when we have everyone operating from the same sheet of music," said Andrea Stark, a reimbursement consultant for MiraVista, a billing and consulting firm in Columbia, S.C.

Providers have also run into problems with Medicaid programs that transitioned to 5010 on Jan. 1 but didn't do proper due diligence beforehand, sources say.

"The Medicaids have been a challenge," said Eric Arnson, vice president of marketing and product management at Capario, a clearinghouse for Brightree. "They didn't have the resources to do the kind of testing like Medicare."

In addition to claims submissions, there have been hiccups with other parts of the claims process, including acknowledgement transactions and electronic remittance advice or ERA transactions. The good news: There's light at the end of the tunnel, sources say.

"We think most problems will be smoothed out by February," Arnson said.