5010 � Ready or Not

							Lakeland Regional Medical Center
         Tips and FAQ’s
 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
 Fieldby 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
 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
 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?
 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
   with any billing change, this has the
 As
 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
 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
 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
 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
 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