AMA – Practice Management Alerts

What you can do if you are experiencing claims processing issues

Since the deadline on January 1, 2012 to convert to the Health Insurance Portability and Accountability Act (HIPAA) Version 5010 transactions, some physicians have been experiencing issues with their claims processing, resulting in lack of payments.

The AMA is aware of issues with claims processing related to the 5010 transition and is addressing these issues directly with the Centers for Medicare and Medicaid Services (CMS). Please inform the AMA and CMS of your issues:

• Report the problems you are having to the AMA with this form.
• Visit www.ama-assn.org/go/clickandcomplain to access additional complaint forms, including the Centers for Medicare and Medicaid Services complaint form.
• Submit your problem to 5010ffsinfo@cms.hhs.gov for issues you are having with Medicare.

Until these issues are resolved, the following are action items that physician practices can take if they are having issues with their claims and interruptions in their cash flow:

• If using a billing service or clearinghouse, contact the billing service or clearinghouse to understand where the problem is occurring. Is it related to the data you are submitting? Is it due to the payers' processing of the claims?
• If you identify a problem with your practice management system, contact your vendor to have the problem resolved.
• If you submit your claims directly to the payer, contact the payer to understand where the problem is occurring. Is it related to the data you are submitting? Is it related to problems within their adjudication system?
• Contact a financial institution about establishing a line of credit.
• Consider submitting paper claim forms to those payers that will accept them.

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