Part B Insider (Multispecialty) Coding Alert

Published on Wed Jun 01, 2011 PDF

Check on your address fields now--before mistakes on your claim forms threaten to halt your Medicare reimbursement.

You should start double-checking your system's provider information and claim forms to ensure that your address fields are 5010-form compliant, or you'll face scores of denied claims once CMS starts requiring the new HIPAA 5010 forms on Jan. 1.

Here's why: If your 5010 claims list your practice's place of service as a P.O. box, your claim will be instantly denied. What's worse? If you're relying on your vendor to do all of your 5010-readiness work for you, you'll be out of luck in this department, because the vendor won't be able to make updates like this for you because they're in your system, not the vendor's data files.

The back story: "Even if your vendor is genuinely and truthfully on top of this, there are things the providers/billers have to do in their systems that vendors cannot do for them," advises Robert B. Burleigh, CHBME, president of Brandywine Healthcare Services in West Chester, Penn. "One of the new distinctions with the 5010 form is between the 'place of service address' and the 'pay to address,'" Burleigh says.

"Under the new 5010 standards, the place of service address (the doctor's practice office location) cannot be a P.O. box--it has to be a street address," Burleigh advises. "If it isn't a street address, the claim will reject. The vendor doesn't have control of what they call the provider master list--the practice or billing company has to make sure that address is a street address."

Important: The "pay to" address can continue to be a P.O. box or lockbox. "The problem is that some of the low-end systems don't have a place for two addresses,"

Burleigh says. "They have just one address field which serves as both the office address and pay to address, and if in the past they were always using a P.O. box, they can no longer do that."

Those practices who maintain lockboxes with P.O. box addresses but who don't have the ability to fill in two different fields will either have to give up their lockboxes so the claim won't be rejected, or use the lockbox address and face claim rejections--both daunting options. Alternately, they'll have to get a software update or upgrade so they can have two fields for the separate addresses.

Testing Day Didn't Amaze

CMS hosted a national 5010 form testing day on June 15, and the results were not surprising -- the majority of practices didn't participate, and those who did found that it primarily focused on claims submission and response--not all of the transactions that providers will utilize, Burleigh said. "For instance, it didn't test for benefit eligibility, verification, or claims status, and that's a big issue," he said.

Keep an eye on future issues of the Insider, where we'll reveal more 5010 form updates that will allow you to be compliant in time for the January deadline.