Are you still submitting claims to your clearinghouse using “Print-Image” files?
If you are still using the print image method for submitting claims, you need to start submitting using the new CMS 1500 02/12 claim form or your cash flow will be negatively impacted.
As October 1, 2015 approaches, the primary concern for all providers is whether or not they will continue to receive revenue as the entire industry makes the biggest transition in healthcare in 35 years! While many practices are finishing off the tail end of their ICD-10 Action Plans, and are well on their way to a smooth transition, we have recently seen a surge in calls from practices that have not yet completed ICD-10 testing with their clearinghouse and payers.
As we are assisting practices with their testing, we are finding a higher than expected number of practices that are sending print image files to their clearinghouses. Most clearinghouses cut off the use of print image files when the industry shifted to the new CMS 1500 02/12 form back on April 1, 2014. However, there are still a few outliers that continued to allow users to submit print image files.
Keep in mind that HIPAA required all electronic transactions to be submitted in the ANSI 5010 format as of January 1, 2012.
In order to comply with this new standard, Medisoft built the capability to submit claims in the 5010 format directly from the program through the Revenue Management module. If you are not using Revenue Management then you are submitting claims in a print image format to your clearinghouse. Then the clearinghouse is converting the print image file for you to the ANSI 5010 format and forwarding it on to the payers.
How You Can Find Out If You Are Sending “Print Image” Text Files
Typically the print image format comes from a file that is formatted based on the HCFA claim form fields. In Medisoft and Lytec the most common method of producing the print image file was by setting up an EDI receiver to launch an executable file called CMS11.exe. Here is a sample of what you may see when you are sending claims that notifies you that you are sending a “print image” text file.
Or you can watch this short video where we show you in Medisoft how you can find out if you are sending “print image” files.
Don’t Let Your Claims Get DENIED
As of Medisoft v19 and Lytec 2014, Medisoft and Lytec discontinued support of the cms11.exe file. It was never updated to match the new claim form or to handle ICD-10 codes. Therefore, if you are still relying on this method to submit claims there is a very high likelihood that your ICD-10 claims will be DENIED starting October 1, 2015.
While some clearinghouses may continue to support print image file submissions, our understanding is that they will require you to use a print image file that produces a print image of the CMS 1500 02/12 claim form. Please take note that the CMS11.exe file produces the old 08/05 claim format and that print image submission is not supported in Medisoft or Lytec.
Get On Board With Revenue Management
The good news is Medisoft v19 (and Medisoft v20) and Lytec 2014 (and Lytec 2015) are both equipped with not only the new 02/12 claim forms, but also with Revenue Management. The Revenue Management module in Medisoft and Lytec can be configured to send claims to any clearinghouse or even directly to the payers in the 5010 format.
In addition, Revenue Management has features such as claim scrubbing and ERA posting that your practice can take advantage of to streamline billing processes.
While the Revenue Management application is included with the ICD-10 compatible versions of Medisoft and Lytec, it does require setup and configuration to successfully utilize it. If you need to get setup on Revenue Management please call us at (888) 799-4777 to schedule the configuration with an EDI Professional!
If You Need Revenue Management Configured, Don’t Wait!
Please do not wait to contact us as the backlog of practices that need configuration and training is growing and our availability is based on first come first serve.
We also highly recommend contacting your clearinghouse as soon as possible to discuss this change, and to coordinate the switch from the print image file to the ANSI 5010 format.