Part B Insider (Multispecialty) Coding Alert

Published on Wed Jun 06, 2012 PDF

Plus: NJ doctor confesses to accepting cash for imaging referrals.

You have just a few weeks left before you'll be expected to meet CMS's June 30 deadline for use of the 5010 transaction standard. To avoid unnecessary rejections, CMS offers the following tips that will combat the most common problems that the agency has seen so far, according to a May 31 email to practices:

• Include a nine-digit ZIP code. If you're still using the old five-digit ZIP code and ignoring the "plus four" digits that the U.S. Postal Service began using several years ago, you could see claims rejections under 5010. "You should work with your vendor to make sure that your system captures the full nine-digit ZIP," CMS advises.
• Use your physical address. You won't be able to file your claims using a P.O. box number as your "billing provider address" under 5010, so you should be sure to record your physical street address under this field. "You can still use a P.O. box, however, as your address for payments and correspondence from payers, as long as you report this location as a pay-to address," CMS notes.
• Record your NPI. You may have grown accustomed to using your employer's Tax ID number as a primary identifier for the billing provider, but those days are over. "For Version 5010 claims, however, you are only allowed to report an NPI as a primary identifier," the agency clarifies.