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5010 vs Revalidation

October 21, 2013

Is 5010 to blame for a decline in your Medicare revenue? 

It is certainly no secret that the implementation of 5010 has resulted in payment issues with various payers, including Medicare.  Email inboxes were flooded with daily updates for EDI issues related to 5010 transition.  Every provider education call hosted by a MAC was consumed by one provider after another lodging a complaint about claim submission problems, hoping that there was a solution, only to hear that a fix was in progress.  As a result, payments were delayed, if not halted altogether for many providers.  The systems issues have diminished and we’re seeing an improvement in the cash flow for Medicare services.

As if that weren’t enough, providers are also faced with the revalidation initiative implemented in the fall of 2011.  What does this mean to you?  It means a great deal of paperwork and potential delays in revenue, if not a loss.  This is a huge deal and one that you need to be prepared for.  By the end of 2011, letters had gone out to more than one hundred thousand providers.  The timelines are very specific.  You have 60-days from the date of the request to submit the completed application.  Failure to do so will result in suspension of payments.  Claims will be adjudicated and ERA’s will be received with the appropriate payment information but no check, paper or EFT. This is the first sign that something is wrong.  Take immediate action because the next step is termination of billing privileges.

FQHC’s can submit the revalidation application via PECOS. This is only an option is you are registered with PECOS.  An Authorized Official must register with PECOS. It can take anywhere from 2-3 weeks for the registration process to be approved.  This will save a significant amount of time when the revalidation request is received as it can be submitted electronically. There may be a few documents that will need to be submitted in hard-copy and of course, there is the requirement of the $523 application fee. The revalidation application will not be processed if received, via paper or electronic, unless there is proof of payment.  If submitting a paper application, print the receipt that is generated from once you submit the payment and include a copy with the application. If submitting via PECOS, payment can be processed without accessing separately.

Make sure that staff is aware and when those letters come in, take immediate action to avoid payment issues later on.

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