Monday, August 13, 2007

Ordering the Correct CMS 1500 version

I will just start by saying always bill Medicare electronically (even secondary claims) if at all possible and then you won't run into this issue:

Back in 2006 Medicare released the first version of CMS 1500 forms (12-90) and recently came out with a newer version of CMS 1500 forms (08-05). On January 1st CMS began accepting the new CMS 1500 forms (08-05) with a planned cut off date of the old forms scheduled for April 1st 2007. CMS then identified formatting issues with the new CMS 1500 forms (08-05) but decided that as of July 2nd 2007 they were still no longer going to accept CMS 1500 (12-90) forms.

Claims were being sent back as of July 2nd when received on this old CMS - 1500 format. However; Medicare has identified that since July 2nd the GPO Government Printing Office was not able to accept and fill orders (they actually create CMS 1500 08/05 forms for use) for the revised form so they recommend buying these CMS 1500 (08/05) forms from other vendors and not directly from Medicare's GPO. When doing a web-search they recommend searching for these key words: "CMS-1500 (08-05)" or "CMS-1500 08/05".


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Group practices need NPI numbers

In order for group practices to bill Medicare electronically they will need a group NPI number. They are required to obtain and use these group NPI numbers to identify themselves as a Billing and Pay-to providers in Medicare claims.

Medicare also requires rendering providers by identified by NPI number on the claims whether or not these rendering providers are covered providers. Group Practices that are enrolled in Medicare will want to ensure that their members (physician or other practitioners) obtain NPI numbers in order to receive payments for the group practice by Medicare.

Office's can have a Facility NPI, Group NPI and individual provider NPI. Verify with Medicare all numbers as they are different.

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McKesson services

I thought I would spend a quick second to tell you about my experience with McKesson Clearinghouse. They are a great clearinghouse that has friendly customer service. My medical billing/practice management software is interfaced with them so I don't get to talk to them much but my cases are resolved if not immediately usually under 72 hours.

I submit CMS-1500, HCFA-1500 & 837 files daily to them and they have so many great reports that help me identify the status of my claims within 24 hours. Also, they send me carrier forwarded reports that give me insight to accepted claims from my insurance carriers within days of submission.

If you are looking for a clearinghouse you may want to look at McKesson. Also, McKesson has purchasing power. In January of 2007 they bought Per-Se Technologies which owns Medisoft and Lytech (I do not use these medical billing software products) and later in the year they bought a hospital front end software. As McKesson stays up with new technologies we all benefit from their services and "extra's" they can offer. I can honestly say I trust them!

To view many Clearinghouses as comparisons I use this website a lot: List and Reviews of Medical Clearinghouses. Once you find one you are interested in click on the name to read more information.

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Medicare NPI numbers and Clearinghouses

Medicare has identified that some clearinghouses are stripping NPI numbers when forwarding the claims on to Medicare. This of course has a huge consequence to the providers including a false sense of security that your claims are actually going to the carrier correctly and without the NPI these claims will not count towards PQRI participation for eligible professionals (losing your Bonus potential).

If you are using ERA (electronic remittance advice) through your clearinghouse don't be fooled just because you see the NPI number on the ERA form. They have also identified that clearinghouses are "adding" these to the ERA even if the claim wasn't transmitted with them.

Medicare of course can not tell you "which" clearinghouses are doing this so they recommend you call your clearinghouse and ask them. Of coure, are clearinghouses going to actually tell us the truth????

Well, for those who may care I use McKesson and I am getting my Medicare payments with using my NPI number on my claims. If you are looking to switch to another clearinghouse McKesson is really good at what they do. Great support, great knowledge and quick turn around on cases. I do trust McKesson with my claims and ERA's.

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National Plan & Provider Enumeration System

Coming in early September medical billing offices will be able to identify NPI numbers for referring providers. Currently the website that will be storing these are located at:
https://nppes.cms.hhs.gov/NPPES/NPIRegistryHome.do

Although they are not viewable yet, I can't wait to be able to search for these. It will cut my office staff time down from not having to call the referring providers.

Thank you Medicare!

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NPI Registry

For those who are still trying to figure out how to get NPI numbers for referring providers Medicare is working on a solution which should be available around September 4th 2007.

NPPES National Plan and Provider Enumeration System is taking these next couple of months to ensure that all providers information is correct prior to placing it on the web. If you are a medical health care provider you will need to submit any possible edits by Monday, August 20, 2007.

This following outline was taken from Medicare's Data Dissemination files:
Health care medical providers can refer to, "Information on FOIA-Disclosable Data Elements in NPPES," dated June 20, 2007 (
http://www.cms.hhs.gov/NationalProvIdentStand/Downloads/NPPES_FOIA_Data%20Elements_062007.pdf ) for assistance in making their edits. Some of the key data elements that are FOIA-Disclosable are:

NPI
Entity Type Code (1-Individual or 2-Organization)
Replacement NPI
Provider Name (First Name, Middle Name, Last Name, Prefix, Suffix, Credential(s), OR the Legal Business Name for Organizations)
Provider Other Name (First Name, Middle Name, Last Name, OR 'Doing Business As' Name, Former Legal Business Name, Other Name. for Organizations)
Provider Business Mailing Address (First line address, Second line address, City, State, Postal Code, and Country Code if outside U.S., Telephone Number, Fax Number)
Provider Business Location Address (First line address, Second line address, City, State, Postal Code, and Country Code if outside U.S., Telephone Number, Fax Number)
Healthcare Provider Taxonomy Code(s)
Other Provider Identifier(s)
Other Provider Identifier Type Code
Provider Enumeration Date
Last Update Date
NPI Deactivation Reason Code
NPI Deactivation Date
NPI Reactivation Date
Provider Gender Code
Provider License Number
Provider License Number State Code
Authorized Official Contact Information (First Name, Middle Name, Last Name, Title or Position, Telephone Number)

This will be a free web-site with no registration required. It will act the same way as the UPIN Registry currenly works.


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