CMS 5010 Delay


On 11/17/11, CMS announced a 90 day delay in the enforcement of the ANSI 5010 claim standard on submitted claims on or after 1/1/12. The reason given was that with only 45 days left before the implementation of 5010 standards, it was determined that a majority of providers were still unable to comply with the new standards based on the current testing thresholds.
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10 Features to consider when choosing Medical Billing Software

The importance of choosing the best Medical Billing System for your Practice or Billing Service is one that has lasting implications and shouldn’t be taken lightly. That’s why we’ve compiled a list of critical features to help you select the best medical billing software for your situation.

  • 1. Processing Claims

    Being able to efficiently process claims is fundamental to the medical claim software. If claims aren’t being paid promptly the financial health of the practice is in jeopardy. Assuming all applications send claims electronically you want to think about features that make the billing process more efficient.

  • 2. Scrubbing Claims

    How easy is it to create and submit clean claims? Resubmissions put a clog in your revenue cycle; getting claims paid the first time should be your top priority. Higher quality billing systems have claim validation functionality to spot possible rejections before claims are submitted.

  • 3. Choice of Clearinghouse

    Can you choose the clearinghouse? Some cheap medical billing software will tie you to using their clearinghouse services – for a not so cheap price. Good electronic medical billing software will allow you to create claim files and upload them to the clearinghouse of your choice. Continue reading

Medi-Cal 5010 Delay Announcement


If you haven’t heard, Medi-Cal has announced that they will not accept claims submitted in the 5010 format after 1/1/12 and that providers should plan to continue to submit Medi-Cal electronic medical claims in the 4010 format for up to one year.

Medi-Cal 5010 Delay Letter

This presents some unique problems for California hospitals and other institutions where payer readiness is an issue.

What will happen at your facility when some payers require 5010 claims and others will not accept them?

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Secure Message Therapy Yields Good Results

ScienceDaily (Sep. 27, 2011) — Treatment via the Internet enables many more patients to get help with their depression, new research suggests. This has been established by the psychologist Fredrik Holländare, who has studied the effects of Internet-based CBT (cognitive behavioral therapy) both on ongoing depression and for preventing relapses. The findings are presented in a doctoral dissertation at the School of Health and Medical Science at Örebro University.

“The purpose of Internet-based treatment is not to replace traditional therapy, face to face, for those who need it. But for many people it is an equally good, even better, alternative, since they can choose their own time and place,” he says.
“There is no single depression treatment that fits everybody. But the more treatments we have, the better the chance of finding the right treatment for the next person seeking help.”
The primary advantage is that more people can get access to treatment that it has created a long waiting list. And for patients who risk relapsing this is an especially welcome improvement, as the shortage of trained CBT therapists limits the possibility of continued treatment. Continue reading

5010 Deadline Fast Approaching

Many people view the 5010 deadline of 1/1/12 as the time when you need to switch from 4010 to 5010 HIPAA transactions. This is not exactly true.  This deadline reflects when 4010 transactions will no longer be accepted by CMS and other payers.  The reality is that CMS expects providers to be sending 5010 transactions BEFORE this deadline.  In order to accomplish this:

  • You must have the ability to create valid 5010 transactions
  • You must have passed testing with your payers
  • You must be placed in production status  

Once this occurs, you can begin sending your claims in 5010 format at any time. 

This should occur well ahead of the deadline to completely eliminate any potential problems that you may have in your system in creating these files properly, reading the associated response files, and most importantly, getting paid.

5010 testing – a survival guide

5010 Testing Tools

Do you really know if you can create a valid 5010 837 claim or not?


Are you really comfortable taking your vendor’s word?  There are ways to verify that this is correct.  First ask your vendor to step you through the process of creating a 5010 using your existing software.   Don’t simply accept a file they create for you, even if it contains your own data.  As far as you know, this file could have been created manually.

Here are two products among many that have been designed to assist you in validating these files.  They are both easy to use and provide detailed results that can be sent back to your vendor.

5010 Deadline Dilemmas Resolved

Many people are under the false assumption that the transition from 4010 to 5010 will happen simultaneously with all payers when the clock strikes midnight on New Year’s Eve.

Based on our previous experiences with similar electronic claim deadlines, there will basically be three different scenarios that will occur based on your preparedness as a provider and the status of individual payers you work with.

  1. 5010 Hipaa transactions can not be conducted because you are not capable of creating them properly.
  2. You can send 5010s to some payers that want them, but not all, because you have not completed 5010 testing with all of them.
  3. Some payers, despite the deadline, are not ready to accept 5010 claims but will continue to accept and process 4010 claims until they can.

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TeleHealth Connect Keeps Patients Connected and Happy

MEDTranDirects new telecomunications product TeleHealth Connect is designed to allow Patients to communicate with their healthcare providers via the internet. 

Patients get all the benifites of an office visit with out the hassle of commuting and scheduling.


Barbara Dameron of TX says “What a great way to stay in touch with our doctor!! With TeleHealth Connect we can get our questions answered without having to play phone tag with our provider. In addition we love the privacy this provides. GREAT JOB!! ” 

Medical Claim Tracking Tool from Emdeon

Emdeon Vision for Claim Management is a new, free, self-service tool available to providers.  Track your claims from submission through payment. 
This tool allows you the same claim views as payers.

Vision Suite for Providers allows access to the previous fifteen months of claims data online.


If using 837Direct to submit claims to Emdeon, this will be available to you.

For inquiries, please contact us at

Drastically Reduce Remittance Processing Time with 835Direct

Published in MEDITECH bulletin June 2010 issue


One vital element of receivables management and cash flow is the processing of insurance payments.  Timely posting of accurate payment and adjustment information can accelerate cash flow by advancing the patient account to the next stage of billing or collections.  Although HIPAA implemented a standard format for electronic remittance of data, the ANSI 835, a majority of the remittance documentation received by hospitals today is still on paper.

The healthcare industry spends 15% of each dollar on payment processing compared to only 2% in retail industries1.  Of the remittances processed by healthcare facilities, 80% – 90% are still provided on paper.

Paper insurance remittances are generally translated manually into payment and adjustment transactions for each documented account.  This process is very time consuming and prone to error.  In addition, vital details about these payments are often excluded in the interest of time.  For example, charge level denials and other detailed adjustments that are often available in the electronic remittances or on the paper equivalent are often summarized or excluded. Continue reading