Orthopedic Coding Alert

Is your software ready to handle the changes? Now's the time to update your billing system software to ensure your office is ready to handle the latest 1500 form revisions from CMS.

Deadline: By April 2007, you-ll have to use the new form to accommodate the new National Provider Identifier (NPI) numbers.

Sound familiar? This change is similar to Y2K or HIPAA Transaction Set deadlines that medical practices have faced before: Your software needs to be ready before this change occurs.

Let our experts guide you through the confusion, and learn what you need to do to prepare. Update Your Software Because of the number of changes and the types of changes that the new CMS-1500 includes, your billing software programs will need updating to correctly print your claims. 

-Accommodating new data fields and allowing for printing adjustments will be a huge pain for everyone, including software vendors,- says Cyndee Weston, executive director of the American Medical Billing Association. -It will likely be a very costly change for billers and providers because some software vendors will use this as an income avenue. And if vendors don't start making changes soon, it's going to cause a lot of problems for end users and clearinghouses.-

Best bet: Talk to your software vendor or clearinghouse as soon as possible. Find out what they intend to do to address the changes and when you can expect upgrades to occur. Get the timeline from your vendor in writing to ensure that they deliver when they say they will. Knowing what to expect and when you can expect it will help make the transition less painful. Using a Clearinghouse Makes Your Job Easier Bonus: If you work with a clearinghouse, you may not have to update your software as quickly as if you submit claims on your own. -Once the new format is required by the carrier, it should still not be necessary for a biller to send claims to the clearinghouse in the new format,- says Gary Lindsay, president of Lindsay Technical Consultants Inc., a clearinghouse in North Mankato, Minn.

Take note: Consider your options, because even though you may be depending on a clearinghouse, there could be times that you need to drop to paper, and your CMS-1500 form would be incorrect if you don't update now. Prepare for Problems Caution: Don't expect the updates and changes to work perfectly the first time. -Billers should not expect the supplemental data fields to work properly on their EDI claims without some glitches,- Weston says. She recommends that billers test the new form before the final deadline. 

Tip: If you use a clearinghouse, ask them what plans they have in place to handle your claims if systems are not updated [...]