Question: When is an 'OR' not an 'OR'? Answer: When Medicare is involved.
I just finished making some programming changes to our ANSI 4010 programs that build our electronic claim files for our practice management software product. You see some of our podiatry clients started getting some rejections from Indiana Medicare recently. After our medical claims support staff did some research we determined that Medicare changed the rules ... again.
This is straight from the Medicare Part B claims specifications for Routine Foot Care that was revised just this month (9/2009) ... And I quote 'If billing electronically, the NPI number of the MD ... providing active care must be reported in the following format: Loop 2310E or 2420D ...' Awesome! We do report this in the 2420D loop and have for years. This is for the specific line item, so that makes sense. Our cleints should be golden!
Well evidently Medicare has decided since publishing this that the wording of 'Loop 2310E or Loop 2420D' actually means you MUST report this is the 2320E or we will reject your claim. Wait, what? Thanks for being clear about that! When did 'or' stop meaning either?What ever happened to the HIPAA standardization? Why has this worked just fine since 2003, but now they need to change things?
The programming change wasn't difficult and has already been made to our medical practice billing software and our clients will be resubmitting claims soon. But consider this the next time you are looking at medical claims software in Indiana or the surrounding states. Who is going to help you interpret what Medicare (or another payer) wants when they start changing the rules. Will your Medical Software Vendor help you determine the best course of action for your practice and quickly make any necessary changes to help get your claims going out and payments coming in?
Bradford-Scott will be. We are committed to helping our clients get the most out of their electronic billing system. And when that means making on demand payer changes to keep claims and payments flowing we will do so as quickly and as accurately as possible.
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