"Cool" Changes under CMS Fee-for-Service's 5010 Implementation

CMS Fee-for-Service (FFS) is the government agency that is responsible for Claims under Medicare Part A and Part B.  They are currently making some really "cool" changes under the 5010 Project that Providers will be glad to hear about.  Something for Health Plans to consider, as they also implement 5010 by the mandated date of January 1, 2012.

1.  CMS FFS will replace their proprietary claims acknowledgement reports with the widely-used 277CA X12N standard format.  The 277CA is already used by most Health Plans to acknowledge the initial receipt of Claims and to communicate any initial status (such as errors).  This is good for Providers because it means they will receive the same format going forward from Health Plans and CMS FFS which makes claims acknowledgement management easier because it can now follow the same process.

2.  CMS FFS will generate their Claim Numbers up front when the Claim is received.  This is great news for Providers because it means they will be given the assigned Claim Numbers up front so that they can immediately use the number to inquire about the status of their Claim.

3.  CMS FFS will be able to receive paper attachments to electronic Claims.  A Provider can fill out a coversheet and fax the attachments to CMS.  CMS will systematically link the electronic claim to the attachment.  This eases the burden on CMS FFS and Providers because it means no extra time is spent looking for paper or proving that an attachment was mailed or faxed.

4. CMS FFS is going to be ready for 5010 by Jan 1, 2011!  That gives Providers and Secondary Payers ONE year to test with CMS FFS before the mandated compliance date.