That is likely the case if you did not upgrade your electronic billing systems to comply with the HIPAA 5010 electronic claims standards. If you didn’t do so by Jan. 1, Medicare, Medicaid, and the commercial insurance carriers probably have not paid your claims.
TMA can help.
The U.S. Department of Health and Human Services required all "covered entities" (physicians, clearinghouses, insurers, and others with access to digital personal health care data) to convert to the new 5010 transaction set by Jan. 1. These are the electronic transactions used to transmit patient, physician, and provider data among those covered entities.
Does this really apply to me? Probably. Check this government chart if you want to make sure.
Despite the government's Nov. 17 announcement that it is delaying enforcement of the HIPAA 5010 electronic claims standards for 90 days, TMA recommends physicians use the new standards if you want to get your claims paid.
From Blue Cross Blue Shield of Texas: Electronic Medicare Crossover Claim Payment Issue
Blue Cross and Blue Shield of Texas (BCBSTX) is experiencing an internal system issue related to electronic Medicare Crossover claims and the delivery of payment. Find out more.
From Availity: Medicare Part B claim rejections The following message was sent out by Availity:
While we are working swiftly on this issue to relieve the pressure on you, we understand your frustration and want to help you get paid as soon as possible. We have identified the appropriate actions you need to take:
We are currently experiencing longer call times, as many people have multiple questions. While we understand your frustration, every call deserves our attention and explanations often require education and discussion. We anticipated your calls and increased our staff to serve you better. We also developed web resources, training tools and tip sheets for self-service when call wait times get too high. Need more information? Contact Availity Client Services at 1.800.AVAILITY (800.242.4548).
From the AMA, "Beyond the Claim: HIPAA 5010 Administrative Simplification Opportunities" webinar helps you learn about the benefits and reasons for migration to and use of the second version of the HIPAA transactions.
Check out these free webinars and handouts from GetReady 5010, a coalition that includes the AMA:
Centers for Medicare & Medicaid Services (CMS) 5010 Resource Page
Compliance guidelines for large practices
Compliance guidelines for small practices
American Medical Association 5010 Resource Page