Ophthalmology and Optometry Coding Alert

Find out how a red arrow on the form can make or break your claims

Don't discard your old CMS-1500 forms just yet. CMS has granted you a respite and will allow the old version (12-90) until June 1, not April 1 as originally planned.
 
Past deadline: Next month, Medicare contractors were supposed to accept only the revised version (08-05), which accommodates the National Provider Identifier (NPI) number.
 
The delay will give everyone, including providers, clearinghouses and vendors, more time to comply with the new form, says Cyndee Weston, executive director of the American Medical Billing Association. "I am doubtful that some software vendors would have been ready by April 1," she adds. Many of them will welcome the delay.
 
Also, some carriers might not have been ready to accept the new form, says Gary Lindsay with Lindsay Technical Consultants in Mankato, Minn.
 
The problem: Print vendors, specifically the Government Printing Office (GPO), are selling incorrectly formatted versions of the revised form, says Brian Reitz, CMS health insurance specialist, in a March 9 Medicare notice.
 
Caution: Submitting incorrect versions of the revised form will delay your payments. Your carrier won't key in a claim using an incorrectly formatted version and will instead return it to you.
 
What to look for: To find out if your CMS-1500 version 08-05 is in danger of bouncing back, look at the upper-right corner of the form. Properly formatted claim forms contain approximately a one-quarter-inch gap between the tip of the red arrow above the vertically stacked word "CARRIER" and the top edge of the paper. "If the tip of the red arrow is touching or close to touching the top edge of the paper, then the form is not printed to specifications," Reitz says.

Beware of 3 Remaining Problems

Even with the delay, the new form will have problems, Lindsay says. There's no space to list the secondary carrier, which all primary carriers require. Physical therapists must list the date of the patient's last x-ray, but there's no space for it. And finally, the carrier's name and address are in the top right-hand corner, which means you can't use a windowed envelope -- because the stamp should go in the upper right-hand corner.
 
Unresolved issue: "We don't exactly know how the claim form delay will play out with the NPI deadline in May," Weston says. "It shouldn't be an issue for electronic transactions. But with paper claims, using old forms without the NPI after the NPI deadline could become an issue."