4010-to-5010 My Filing Nightmares
Rejected Claims, Unreadable Reports, and Error Messages, Oh My!
Has the 4010 to 5010 transition confused you or your office staff with rejected claims, unreadable reports, and/or error messages? The following are some helpful websites and information my staff gathered while making the fun transition.
http://www.ama-assn.org/resources/doc/washington/4010-to-5010-claim-data-reporting-comparison.pdf
If you upload your claims using a clearinghouse your should get a human readable electronic report. (If you are getting a human readable report, count yourself lucky!) However, if you upload your claims directly to the Medicare Carrier you might only get a 999 file and a 277CA file. Acknowledgement for Health Care Insurance (999) and Claims Acknowledgements (277CA) will open in Notepad and contain a couple lines of code in your report because they no longer require themselves to send human readable reports. Talk to your software company and ask if they can provide the translation software. There HIPAA EDI Viewer software companies out there. More info about this topic:
http://www.wpsic.com/edi/5010-Readiness.shtml
https://www.cms.gov/Versions5010andD0/Downloads/2nd_National_Provider_Education_Call_HIPAA_Versions_5010_and_D0.pdf
If you have any questions, or suggestions please feel free to post them below. We are always looking for more information to share.
~Dr. Street
Wednesday, January 25, 2012
Wednesday, January 11, 2012
Compliance 2012
Chiropractic Medicare
"Compliance 2012"
Dear Doctors and Staff,
2012 should be an exciting year, especially for those taking the step forward, becoming compliant in Medicare and going paperless. Big step....however, if you plan on being in practice in 2015, this is the year to get into action.
Three areas are critical for Chiropractors who wish to stay in practice after 2015.
1. We must know and follow the Medicare guidelines. We have all signed a contract with CMS that we know and will follow all the rules in Medicare. With Chiropractors across the USA having a 67% Error Rate, even just filing a Medicare claim, it's pretty obvious most Chiropractors think they know how to do Medicare, but they don't. They usually find that out after a failed audit and a donation of money back to the Medicare carrier.
2. We must be protecting personal health information that we have collected on our patients in our office. Specific guidelines and procedures must be followed by the doctor and all staff at all times. Those procedures and policies of how your are protecting personal health information must be made available to your patients.
3. We now have 11 1/2 months to become Medicare Compliant. There are seven areas specifically presented by the government that we are required to address. We are required to take specific action steps, develop policies and procedures, appoint Compliance Officers, etc. It's no little job, but it is required by the government.....only if you plan on being in practice in 2015.
We do offer a Compliance Guide Book and CD. Policies and procedures are completed, ready to be reviewed, and can be used as your Medicare Compliance Program. It took me 2 1/2 months to develop.
Do you know the importance of learning the correct way to do Medicare by federal standards and becoming Medicare Compliant?
Have questions? Give me a call today 618-395-3800.
~Dr. Gary R. Street
"Compliance 2012"
Dear Doctors and Staff,
2012 should be an exciting year, especially for those taking the step forward, becoming compliant in Medicare and going paperless. Big step....however, if you plan on being in practice in 2015, this is the year to get into action.
Three areas are critical for Chiropractors who wish to stay in practice after 2015.
1. We must know and follow the Medicare guidelines. We have all signed a contract with CMS that we know and will follow all the rules in Medicare. With Chiropractors across the USA having a 67% Error Rate, even just filing a Medicare claim, it's pretty obvious most Chiropractors think they know how to do Medicare, but they don't. They usually find that out after a failed audit and a donation of money back to the Medicare carrier.
2. We must be protecting personal health information that we have collected on our patients in our office. Specific guidelines and procedures must be followed by the doctor and all staff at all times. Those procedures and policies of how your are protecting personal health information must be made available to your patients.
3. We now have 11 1/2 months to become Medicare Compliant. There are seven areas specifically presented by the government that we are required to address. We are required to take specific action steps, develop policies and procedures, appoint Compliance Officers, etc. It's no little job, but it is required by the government.....only if you plan on being in practice in 2015.
We do offer a Compliance Guide Book and CD. Policies and procedures are completed, ready to be reviewed, and can be used as your Medicare Compliance Program. It took me 2 1/2 months to develop.
Do you know the importance of learning the correct way to do Medicare by federal standards and becoming Medicare Compliant?
Have questions? Give me a call today 618-395-3800.
~Dr. Gary R. Street
Tuesday, January 3, 2012
Happy New Year 2012
Chiropractic Medicare
"Happy New Year 2012"
Dear Doctors and Staff,
The window to change your participation status in Medicare ended Saturday, December 31st. I hope you made sure to send any request for change of status by certified mail.
Congress did pass the 2 month extension bill that assures our Medicare reimbursement fees will not be decreased on January 1st by 27%. However, that extension is only for two months. Our Medicare reimbursement will probably be a little higher in January 2012 than what it was in 2011 because of relative values. To check your specific fees.... go to your Medicare Carrier web site, search fees. On about page 245? you will come to 98940, 98941, 98942. The code without the pound (#) sign will be your fees in your local. If the fees you see are still decreased.... your Medicare Carrier does not have the new fees posted as of yet.
Software contractors for electronic billing should have met their mandated deadline to be in compliance for 2012. They must be prepared with the 5010 software that begins our compliance process in 2012 to start using the ICD-10 codes.
We Chiropractors and staff must also become compliant in Medicare if we plan on being in practice five years from now. While the Chiropractic Medicare Compliance is voluntary, in the first 5 years it carries substantial positive incentives that makes it attractive to all eligible entities. However, entities that do not demonstrate "meaningful use" of electronic health record technology will be subject to significant Medicare payment reductions after the fifth year.
Questions? Please give me a call.
Dr. Gary R. Street
618-395-3800
"Happy New Year 2012"
Dear Doctors and Staff,
The window to change your participation status in Medicare ended Saturday, December 31st. I hope you made sure to send any request for change of status by certified mail.
Congress did pass the 2 month extension bill that assures our Medicare reimbursement fees will not be decreased on January 1st by 27%. However, that extension is only for two months. Our Medicare reimbursement will probably be a little higher in January 2012 than what it was in 2011 because of relative values. To check your specific fees.... go to your Medicare Carrier web site, search fees. On about page 245? you will come to 98940, 98941, 98942. The code without the pound (#) sign will be your fees in your local. If the fees you see are still decreased.... your Medicare Carrier does not have the new fees posted as of yet.
Software contractors for electronic billing should have met their mandated deadline to be in compliance for 2012. They must be prepared with the 5010 software that begins our compliance process in 2012 to start using the ICD-10 codes.
We Chiropractors and staff must also become compliant in Medicare if we plan on being in practice five years from now. While the Chiropractic Medicare Compliance is voluntary, in the first 5 years it carries substantial positive incentives that makes it attractive to all eligible entities. However, entities that do not demonstrate "meaningful use" of electronic health record technology will be subject to significant Medicare payment reductions after the fifth year.
Questions? Please give me a call.
Dr. Gary R. Street
618-395-3800
Friday, December 30, 2011
A New Year to Become Compliant in Chiropractic Medicare
Newsletter
December 20, 2011
A New Year to Become Compliant in Chiropractic Medicare
Dear Doctors and Staff,
1. We are in the window.
2. Congress ready for Medicare fee vote.
3. Three areas to contend with in 2012.
4. Chiropractic Medicare Compliance Program available.
1. We are in a window:
The month of December is the window available by our Medicare carrier to change from Participating Provider to Non-Participating or Non-Participating Provider to Participating Provider Part B Medicare effective January 2012.
For those who have attended our Presentation in the past or have purchased "The Basics" Chiropractic Medicare DVD, the hand-out booklet page 42 contains an example letter that must reach your Medicare carrier prior to the end of the year. Mail this letter certified mail, this being your proof they have received your request to change your participating status.
2. Congress ready for Medicare fee vote: (Action Step request!)
At the present time congress is still in session and soon voting on the large package bill that will preserve our present fees in Medicare. (Probably even a small raise.) National News will report on this package bill as it has to do with withholdings. etc, by the employer. Please call your Congressmen and Senators asking them to vote for this bill.
3. We Chiropractors have three (3) critical areas we must be prepared for as we go into 2012:
A. We must know the correct way to do Medicare so we don't get into trouble.
B. We must know how to protect Personal Health Information in our offices.
C. We must become Medicare Compliant by the end of 2012. There are seven (7) areas we must have prepared written policy and procedure training, hiring, self audits and reporting.
4. Chiropractic Medicare Compliance Program Book & CD:
The Book is ready to help you start implementing Medicare Compliance in your practice. Just add your office name, etc., and follow the instructions and you are well on your way to becoming compliant in Medicare.
December 20, 2011
A New Year to Become Compliant in Chiropractic Medicare
Dear Doctors and Staff,
1. We are in the window.
2. Congress ready for Medicare fee vote.
3. Three areas to contend with in 2012.
4. Chiropractic Medicare Compliance Program available.
1. We are in a window:
The month of December is the window available by our Medicare carrier to change from Participating Provider to Non-Participating or Non-Participating Provider to Participating Provider Part B Medicare effective January 2012.
For those who have attended our Presentation in the past or have purchased "The Basics" Chiropractic Medicare DVD, the hand-out booklet page 42 contains an example letter that must reach your Medicare carrier prior to the end of the year. Mail this letter certified mail, this being your proof they have received your request to change your participating status.
2. Congress ready for Medicare fee vote: (Action Step request!)
At the present time congress is still in session and soon voting on the large package bill that will preserve our present fees in Medicare. (Probably even a small raise.) National News will report on this package bill as it has to do with withholdings. etc, by the employer. Please call your Congressmen and Senators asking them to vote for this bill.
3. We Chiropractors have three (3) critical areas we must be prepared for as we go into 2012:
A. We must know the correct way to do Medicare so we don't get into trouble.
B. We must know how to protect Personal Health Information in our offices.
C. We must become Medicare Compliant by the end of 2012. There are seven (7) areas we must have prepared written policy and procedure training, hiring, self audits and reporting.
4. Chiropractic Medicare Compliance Program Book & CD:
The Book is ready to help you start implementing Medicare Compliance in your practice. Just add your office name, etc., and follow the instructions and you are well on your way to becoming compliant in Medicare.
Tuesday, December 13, 2011
Chiropractic Medicare Compliance Guide & CD of Forms ~Newsletter 12/12/11
Newsletter
December 12, 2011
Chiropractic Medicare
Compliance Book & CD Ready for 2012
We are taking orders!
Dear Doctors and Staff,
It is finally completed! After 2 1/2 months of late nights, hard work, critical thinking and research, "The Basics" Chiropractic Medicare Compliance Guidebook and CD are finished.
Most of my fellow Chiropractors are aware we "must be in Medicare Compliance" by the end of 2012. Our Medicare Compliance Program is ready. Just add your office data, names, address and a few additional personnel changes, then print the policies, procedures, guidelines, etc., that have already been completed for you.
Knowing the importance of learning the correct way to do Medicare by federal standards and becoming Medicare Compliant is the important thing to do in Medicare in 2012. We have a program and its ready to be implemented in your office. My Compliance Guide will save you and your staff hours of hard work. (I know that for a fact!)
REMINDER NOTE: We are presently in the window to change your Medicare provider status. You can change to Participating Provider or to Non-participating Provider, the time to do that is NOW!
December 12, 2011
Chiropractic Medicare
Compliance Book & CD Ready for 2012
We are taking orders!
Dear Doctors and Staff,
It is finally completed! After 2 1/2 months of late nights, hard work, critical thinking and research, "The Basics" Chiropractic Medicare Compliance Guidebook and CD are finished.
Most of my fellow Chiropractors are aware we "must be in Medicare Compliance" by the end of 2012. Our Medicare Compliance Program is ready. Just add your office data, names, address and a few additional personnel changes, then print the policies, procedures, guidelines, etc., that have already been completed for you.
Knowing the importance of learning the correct way to do Medicare by federal standards and becoming Medicare Compliant is the important thing to do in Medicare in 2012. We have a program and its ready to be implemented in your office. My Compliance Guide will save you and your staff hours of hard work. (I know that for a fact!)
REMINDER NOTE: We are presently in the window to change your Medicare provider status. You can change to Participating Provider or to Non-participating Provider, the time to do that is NOW!
Friday, November 25, 2011
Are YOU Knowing the Correct Way to Chiropractic Medicare Compliance? ~Newsletter 11/25/11
Newsletter
November 25, 2011
Chiropractic Medicare Compliance, HIPAA and
Knowing the Correct way to do Medicare
Dear Doctors and Staff,
Having spent hours, this and last month, working on documents, forms, data, office policies,and reports necessary to become Medicare Compliant in 2012, it should be completed and ready to go by November 30th.
Two points of interest:
1. After going through ALL the "stuff" required by federal law - I can't imagine very many offices will prepare this themselves.
2. The fee we have set to sell this program is worth every dime!
The manpower, critical thinking and production of the Chiropractic Compliance Program material is staggering, let alone, understanding and producing all the different office policies for all the different categories each office must produce. If done correctly, the implementation of the Medicare Compliance Program, with self-audits and all the policies, will have a positive effect on the Chiropractic Error Medicare Rate.
Those Chiropractors that do not go through or implement this program will stand out like a sore thumb and I am sure will be in prime position for audits from their specific Medicare carriers.
There are three (3) specific areas we chiropractors must understand and implement in our practices:
1. Learning the correct way to do Chiropractic Medicare ("The Basics" Chiropractic Medicare DVD and Booklet)
2. Protecting patient Personal Health Information (Chiropractic HIPAA book and CD)
3. Chiropractic Medicare compliance with written policies to prevent fraud and abuse in the Medicare program (Chiropractic Compliance Program book and CD)
The most profound problem we Chiropractors face is the lack of knowledge of how the Chiropractic Medicare actually functions and what is specifically needed to "document" the Chiropractic necessity of care. (Not S.O.A.P. notes) If you become Medicare compliant, as mandated by 2012, and still make errors in "documentation"....you have gained nothing.
Recommendation:
For those D. C's and staff that have attended our seminars, or have purchased our Chiropractic Medicare DVD, consider ordering our NEW Chiropractic Compliant CD & book. You are on the safe road for Chiropractic Medicare Compliance!
For those D.C.'s that do not have, or know about "The Basics" Chiropractic Medicare DVD or our Seminars, we have put together a bundle so you can get all the important information at a very good cost. Please call me for more information 618-395-3162 or 800-MY-CHIRO.
Regards,
Dr. Street
November 25, 2011
Chiropractic Medicare Compliance, HIPAA and
Knowing the Correct way to do Medicare
Dear Doctors and Staff,
Having spent hours, this and last month, working on documents, forms, data, office policies,and reports necessary to become Medicare Compliant in 2012, it should be completed and ready to go by November 30th.
Two points of interest:
1. After going through ALL the "stuff" required by federal law - I can't imagine very many offices will prepare this themselves.
2. The fee we have set to sell this program is worth every dime!
The manpower, critical thinking and production of the Chiropractic Compliance Program material is staggering, let alone, understanding and producing all the different office policies for all the different categories each office must produce. If done correctly, the implementation of the Medicare Compliance Program, with self-audits and all the policies, will have a positive effect on the Chiropractic Error Medicare Rate.
Those Chiropractors that do not go through or implement this program will stand out like a sore thumb and I am sure will be in prime position for audits from their specific Medicare carriers.
There are three (3) specific areas we chiropractors must understand and implement in our practices:
1. Learning the correct way to do Chiropractic Medicare ("The Basics" Chiropractic Medicare DVD and Booklet)
2. Protecting patient Personal Health Information (Chiropractic HIPAA book and CD)
3. Chiropractic Medicare compliance with written policies to prevent fraud and abuse in the Medicare program (Chiropractic Compliance Program book and CD)
The most profound problem we Chiropractors face is the lack of knowledge of how the Chiropractic Medicare actually functions and what is specifically needed to "document" the Chiropractic necessity of care. (Not S.O.A.P. notes) If you become Medicare compliant, as mandated by 2012, and still make errors in "documentation"....you have gained nothing.
Recommendation:
For those D. C's and staff that have attended our seminars, or have purchased our Chiropractic Medicare DVD, consider ordering our NEW Chiropractic Compliant CD & book. You are on the safe road for Chiropractic Medicare Compliance!
For those D.C.'s that do not have, or know about "The Basics" Chiropractic Medicare DVD or our Seminars, we have put together a bundle so you can get all the important information at a very good cost. Please call me for more information 618-395-3162 or 800-MY-CHIRO.
Regards,
Dr. Street
Wednesday, November 16, 2011
IPSCA Medicare Compliance Seminar in Moline, Illinois (Dec. 8th)
On Thursday, December 8th, 2011, the Illinois Prairie State Chiropractic Association (IPSCA) is holding a seminar in Moline, Illinois. Dr. Street will be there to speak on Chiropractic Medicare Compliance.
IPSCA website: http://illinoischiropractors.org/
Link directly to the form below: http://illinoischiropractors.org/uploads/Medicare_Compliance.pdf
IPSCA website: http://illinoischiropractors.org/
Link directly to the form below: http://illinoischiropractors.org/uploads/Medicare_Compliance.pdf
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