5010 Transition

February 2, 2012

To everyone that is reading this;

Many of you are aware that CMS has mandated a move from an electronic medical

claims billing format called 4010 to a newer format called 5010. No one should

be surprised by that statement, since it has been coming through the pipeline

for quite some time. However, like anything significant that comes out of

Washington, there is a period of time between when something is decreed and when

enough examples of the how things can be interpretted can be addressed.

Usually, a significant change like this is mandated to occur on a certain date

and then our government regulators realize that there are enough issues in the

interpretation of the regulations to postpone the implementation for a

reasonable period of time. In the past, these postponements have taken as long

as a year. This time I believe the delayed implementation was for 60 or 120

days (I am sure someone reading this knows the deadline and can clarify). The

deadline for implementation was January 1st and the fun is now starting. With

all that said, Turney, CEO of MGMA (Medical Group Management Association)

has recently written a letter to Kathleen Sebelius, Secretary of the Department

of Health and Human Services requesting relief to all providers from having to

comply with 5010 requirements until a later date (at least June 30th, 2012). I

have a copy of this 3 page letter dated 2/1/12 in Adobe, otherwise I would have

done a cut and paste job in the body of this email.

The bottom line is that providers have passed 5010 testing and been approved to

submit claims in the 5010 format, only to have encountered problems with their

MAC's (Medicare Contractors). For those involved in the billing process, this

is not a surprise. For those awaiting the results of the billing process, you

might be experiencing frustration with your cash flow and immediately wondered

if your biller is addressing 5010 issues appropriately. All I would say is to

be patient and lobby your United States Senators and Congressmen hard. Because

your cash flow, expenses and labor in the billing process are being pushed to

the limit.

Jim Hall, CPA <///><

General Manager

Rehab Management Services, LLC

Cedar Rapids, IA

319/892-0142 X 110

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