What a wild and crazy ride 2012 has been so far! In addition to the many Medicare billing changes effective in January and April, we are dealing with provider enrollment revalidations and the conversion to the version 5010 electronic claims format.
As of the deadline for this issue, I have heard stories of providers not being paid for weeks or months by Medicare and other payers due to 5010 issues. At our billing company we have seen a batch of claims sent to a payer sail through with no problems, but another batch of claims filed the same day for the same provider to the same payer have disappeared, rejected, or been processed, but not paid.
MEDICARE ENROLLMENT REVALIDATION NIGHTMARES
Medicare provider enrollment revalidations have been another nightmare for some providers. We have two clients who submitted their revalidations on time and still had their payments suspended. For one provider it took about a week to have the payments reinstated, but it took about a month for the other provider.
SEND ME YOUR STORIES
I would like to share your experiences with 5010 and revalidation issues in a future column. Please send your experiences to me at firstname.lastname@example.org.
HIPAA PRIVACY AND SECURITY
I recently participated in a billing webinar in which a number of HIPAA and HITECH issues were discussed. The questions submitted by participants indicated there are still misunderstandings and confusion involving the privacy and security of Protected Health Information (PHI).
How to appropriately handle and secure PHI should be part of every medical biller’s ongoing training. Situations continually arise where an unprepared biller can make an error that can be very costly to their patients and their employers. This month we’ll examine one of the biggest ongoing PHI issues facing all of us in healthcare billing.