As your billing personnel are well aware, CMS initially mandated a strict deadline of December 31, 2011, for sending Medicare claims and receiving remittances in 5010 format, after which claims would not be paid. The pressure by the Medicare carriers was intense, literally threatening the livelihood of all providers who did not comply.  But wait!

On November 17, 2011, CMS effectively extended the deadline for 5010 compliance until March 31, 2012.

So, how do you get ready for 5010? Among the options are:

1. Changing your billing software to allow creation of claims in 5010 file format, test with Medicare, and move to production. This option allows you to gain greater control of the process, but requires upgrading your billing software – which may be expensive.
2. Using a Clearinghouse which will convert your current 4010 file format to a 5010 file format. This option is cost effective since it does not require the purchase of new billing software, but will usually engender monthly Clearinghouse fees.
3. Using a Software Vendor which will convert your 4010 file format to a 5010 file format. This option is cost effective since it does not require the purchase of new billing software, does not require monthly fees, but only an annual service fee to the Software Vendor. In addition, some Software Vendors will allow free commercial claims to be sent.

Because the deadline has been extended, providers are in a better position to review all options, and make a sound business decision.

Contributed by Bruno Stillo, Physiatry Billing Specialists, (800)835-4482, [email protected]

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