Is Your Billing Service Ready for 5010? It’s Your Cash Flow!

As part of the change to the 5010 version of the HIPAA transaction standards starting in 2012, practices will no longer be permitted to use a PO box or lock box address as the “billing provider” address to receive payments. For electronic claims, a street address or physical location is required as the billing provider address. The Centers for Medicare & Medicaid Services (CMS) report that the PO box issue is one of the leading causes of test claim rejections. CMS has indicated it will reject Medicare claims that continue to
report a PO box in the billing provider address field.  

Under HIPAA, all physicians and other healthcare providers that submit claims electronically are required to transition to the Version 5010 transactions by Jan. 1, 2012. Practices that wish to continue having payments sent to a PO box or lock box must report this address in the “pay-to” address field.

Practice administrators should ensure that their practice management system vendor, billing service or clearinghouse has made this change. Practices must update their address information before Jan. 1 to prevent claims rejections and interruptions in cash flow.  Commercial payer are implementing the 5010 standards as well, so be ready to trouble shot the commercial payers claims denials or prepare for a significant cash flow impact.

Visit or the CMS Web site for more information on the change to Version 5010.

ACO Resources now available from CMS

The Centers for Medicare & Medicaid Services’ Medicare Learning Network
is offering several resources for providers looking for information on accountable care organizations and the Medicare Shared Savings Program.

Several electronic fact sheets that address topics are now available, including how to participate in an ACO and improve quality of care and information on the advanced payment model for ACOs. New fact sheets are also available detailing final rule provisions for ACOs under the shared savings program and fact sheets provide information on the methodology for determining shared savings and losses under the program.