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Avoid rejected claims; note the billing address change for 5010
e-Reports, Dec. 19, 2011
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TRIAGE: INTERPRETING, EXPLAINING IMPORTANT NEWS FOR YOUR PRACTICE Untitled document

Do you use a post office box or lock box address as your billing provider address for payments? Under Version 5010 starting Jan. 1, if you submit claims electronically, you will be required to use only a street address or physical location as the billing provider address. Continuing to report a post office box in the billing provider address field will cause your claims to be rejected.

Under the Health Insurance Portability and Accountability Act (HIPAA), all physicians and other health care providers submitting claims electronically are required to transition to the Version 5010 transactions with the new year. One of many data reporting changes in 5010 is the requirement to report only a street address or physical location as the billing provider address.

If you want to continue having payments sent to a post office box or lock box, report the box address in the “pay-to” address field.

Work with your practice management system vendor, billing service or clearinghouse to make this address change for your claims. Talk to them today to find out if a change is needed and when it will occur, since it must happen by the first of the year to prevent claim rejections and interruptions in your cash flow.

Visit the AMA website or the CMS website for more information on data reporting changes in the Version 5010 transactions and to prepare your practice for the Jan. 1 deadline.

Don’t forget new ABN form for 2012
The Centers for Medicare & Medicaid Services (CMS) revised the Advanced Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131, used when Medicare is expected to deny payment. The revised form, mandatory as of Jan. 1, replaces ABN-G (form CMS-R-131G), ABN-L (form CMS-R-131L), and NEMB (form CMS-20007).

Find the latest version of the ABN (with release date of 3/2011 in the lower left-hand corner) here.

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