In case you haven’t heard, several deadlines have been detoured lately – some pushed back, some here, some coming who knows when…. Here they are, followed by some commentary:
HIPAA 5010 Format Conversion “Non-Enforcement Period” Extended
If you bill electronically, you must convert to the 5010 format in order to have your claims “read” properly and to receive insurance reimbursement. This rule went into effect January 1, 2012 with a grace period (known as the non-enforcement period) through March 31, 2012. The non-enforcement period has now been extended to June 30, 2012. During the non-enforcement period, payers are instructed to accept claims in the old 4010 format and the new, required 5010 format. After that period is now over, payers no longer have to accept claims in the 4010 format; nor do they have to extend you the chance to resubmit your claims in the correct format. If you haven’t converted to the 5010 format yet – you still have a chance!
Dr. Tom’s comments: Do it before you risk non-payment! It is not complicated and you have no reason to resist as it is eventually going to be required – soon. For more info, see
The Department of Health and Human Services (HHS) announced a proposed rule that would set October 1, 2014 as the new compliance date for the International Classification of Diseases, 10th Edition diagnosis and procedure codes (ICD-10). This date is in response to the previous deadline of October 2013, which was announced as delayed, but a new deadline was not proposed at the time. For the entire ICD-10 Press Release.
Dr. Tom’s comments: As predicted and stated in my previous posts, ICD-10 keeps getting pushed back for years now. It probably will happen at some point in the future. Whether that is 2014 remains to be seen. I would caution against training your staff and sending them to ICD-10 seminars at this juncture because the deadline may be too far away for them to retain the information. This means you will have to repeat the seminar – good for the instructor or the entity putting on the seminar, not so good for you.
EHR Incentive Deadline Extended
CMS is extending the deadline for eligible professionals (EPs) to submit eligibility appeals under the Medicare Electronic Health Record (EHR) Incentive Programs 2011 payment year. The new deadline is April 30, giving EPs an extra month to file their appeals.
An eligibility appeal allows a provider to show that all the requirements for the Medicare EHR Incentive Program were met and that he or she should have received a payment but could not because of circumstances outside of the provider’s control.
CMS affords providers with a two-level appeal process: an informal review and a request for reconsideration. Within the two-level appeal process, there are three types of appeals that can be filed in the Medicare EHR Incentive Program: eligibility, meaningful use and incentive payment appeals.
Detailed guidance on the appeals process and additional information on all of the appeal types are available on the CMS Office of Clinical Standards and Quality Web site.
Dr. Tom’s comments: If you are on EMR already and see more than a handful of Medicare patients per week, this may be worth looking into and getting your $$ for 2011 claims while you can. It is not that complicated and may be worth your time spent.
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