Medical Billing Blog

5010 Update: Medical Billing Company Recommends Holding Some Cash

Posted by Barry Shatzman on Fri, Dec, 30, 2011 @ 13:12 PM

5010Logo resized 600By now every provider should be aware of 5010. 5010 is the new electronic claims transmission format that becomes effective January 1, 2012. Commercial and grvernment payers are all required to use this new format.

We have been successfully processing all claims in the 5010 format for a month or so. I still recommend saving some extra cash in case payer systems have unforeseen issues and either hold claims or outright reject claims due to the 5010 format.

Everyone is saying they are prepared. Medicare, Blue Cross, commercial payers, EDI's are all saying they are ready. In spite of this, it is common knowledge that software upgrades can have unforeseen problems, especially when they are the size and scale of this one. This affects everyone, and it's a massive transition.

Reimbursements willc ontinue in January from November and December claims, while simultaneously new claims could be rejected due to 5010 issues. By February, typically a practice's slowest collection month, co-pays are still being met, resulting in smaller checks from insurance companies. Between reduced reimbursements from applied co-pays and the possibility of rejected claims resulting in delayed payments due to 5010, together this could cause serious cash constraints for any practice.

Because of this, we are still suggesting that everyone either set some cash aside or open a line of credit to help with your cash flow through the beginning of the year. We suggest holding on to enough cash to get your practice by for a couple of weeks or months if problems develop after implementation int he first quarter of 2012.  Once again, it's better to have money you don't need than to need money you don't have.