HIPAA 5010: Can I Revert to Paper Claims?

Q. I am still struggling with my vendor to comply with HIPAA 5010 during the Medicare grace period that ends March 31. I currently file claims electronically. Can I just go back to paper for all my claims?    

A. Under Medicare, there are only two possible ways a practice could file paper claims:  

Each of these situations most likely would have been established when the electronic billing requirement went into place in 2003.   

Given that you are already filing electronically, more than likely you did not meet these requirements in 2003. Additionally, it is unlikely that the Centers for Medicare & Medicaid Services(CMS) would approve the inability to submit 5010 claims by your vendor as an “unusual circumstance” because CMS is offering more time and other vendor alternatives so you can bill Medicare electronically.

Your commercial plans may have a different deadline for converting to 5010. Check to find out how long they will accept 4010 transactions. Generally, commercial payers accept paper claims (under state law, they must accept paper claims from practices with fewer than 10 employees). However, to drop to paper, you must apply to these carriers individually for a waiver. In addition, you will need to change your status with all of your payers because your current credentials and contracts are set for electronic transactions. Moreover, you can expect a three-fold increase in the length of time to get paid.

If you don’t think you can be ready for 5010 in time, make a contingency plan to avoid a disruption in cash flow in your practice. You may need to rely temporarily on a clearinghouse or billing service.

If you do switchto paper just to get your claims paid — continue working to become 5010 compliant so you can go back to electronic claims submission. The many benefits of submitting claims electronically are many, not the least of which are fewer errors and faster payment. TrailBlazer Health Enterprises reports that Medicare’s claims payment floor is 14 days for electronic claims, compared with 29 days for paper.

Published Jan. 17, 2012

TMA Practice E-Tips main page