WMGMA

Medicare / Medicaid

Medicare

Medicaid

Medicare / Medicaid WG

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Online membership applications are temporarily unavailable. For a regular/associate membership application, click here. For an affiliate membership application, contact the WMGMA office at 920-560-5621 or lona@badgerbaymanagement.com.

Medicare

Sharing of Information - HIPAA 2

Posted March 24, 2010

The Health Insurance Portability and Accountability Act of 1996 mandated that the healthcare industry use standard formats for electronic claims and claims related transactions. The Secretary of the Department of Health and Human Services (HHS) adopted ASC X12 version 5010 and NCPDP version D.0 as the next HIPAA standard for HIPAA covered transactions on January 16, 2009.

Transition to the new format for Medicare fee-for-service (FFS) begins on January 1, 2011. By January 1, 2012 you must be ready to submit your claims electronically using the X12 Version 5010 to Medicare and other payers. Medicare does not anticipate extensions to these deadlines.

The implementation will require changes to the software and perhaps procedures that you use for billing Medicare and other payers. It is extremely important that you are aware of these HIPAA 2 changes and plan for their implementation.

If you rely on your vendor or clearinghouse to maintain your billing system and keep you up-to-date with electronic transactions, you need to ask your vendor and or clearinghouse about their plans for transitioning to the new 5010 format.

If you fail to prepare, you may not be able to send electronic claims or receive electronic remittances, significantly impacting your business and cash flow.

Please take a few minutes to review the following fact sheets and share with those in your organization who need to know this information.

Fact Sheets:

New Health Care Electronic Transactions Standards Versions 5010, D.0, and 3.0

Preparing for Electronic Data Interchange (EDI) Standards: The Transition to Versions 5010 and D.0

FAQs About the Elimination of Consultation Codes
posted 2/2/2010

As most of you are aware, CMS eliminated consultation codes for Medicare Part B patients in the 2010 Medicare Fee Schedule. An FAQ was designed for MGMA members which MGMA has now decided to provide this FAQ for state members. Click here to access the FAQ.