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News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups

Hosted by Robert Michel
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HIPAA Form 5010 Implementation: Real-World Solutions to Ease the Transition from 4010 to 5010 and Avoid Reimbursement Delays

HIPAA Form 5010 Implementation: Real-World Solutions to Ease the Transition from 4010 to 5010 and Avoid Reimbursement Delays

The first 18 days: Lessons learned about how labs can generate clean lab-test claims for speedy payment



Lâle White, Executive Chairman and CEO, XIFIN, Inc

Jackie Griffin, Director, Client Services, Training & Project Implementation, Gateway EDI

Matt Warner, Associate Vice President, Operations, XIFIN, Inc.

Every clinical lab is about to learn whether the transition to form 5010-required as of January 1, 2012-will be handled flawlessly by payers or not.

Ideally, clean claims should mean that payers send timely remittances to your lab. But things are less than perfect. Certain payers have already admitted that they weren’t 100% ready for form 5010 implementation on January 1. And in the days since, other payers have struggled to process claims in a timely fashion. Even your own lab’s billing and collections department probably already has stories to tell about unexpected payer glitches.

Join THE DARK REPORT and held on Wednesday, January 18, 2012 and listen as two nationally prominent experts on billing and collections give you up-to-the-minute news and intelligence about the successes and setbacks payers are having with form 5010 implementation.

The timing couldn’t be better, because you’ll have a front-row seat to hear the latest developments in how payers are handling 5010 implementation. You’ll learn which payers are processing 5010 claims in an exemplary fashion. But you’ll also find out which payers have been overwhelmed by the transition-along with tips that can help your lab avoid these issues when it files its own claims with these payers.

First up is Lâle White, CEO at XIFIN, Inc. Last year, XIFIN submitted more than one million 5010 live claims for their lab clients and found a number of problem areas. White will provide an in-depth review of those problems as well as what your lab can do to avoid them. You’ll also learn what’s being done to resolve these problems going forward.

“Don’t underestimate the importance of having in-house expertise to help you identify, investigate, and resolve problems,” says White. “Because if a claim is rejected, you won’t necessarily know why.” Find out what tools you’ll need to ensure that 100% of claims can be reconciled and errors can be easily found-and resolved.

Next you’ll hear from Jackie Griffin, Director, Client Services for Gateway EDI. She’ll talk about Gateway’s experiences with how different payers are handling 5010 claims. As one of the nation’s fastest-growing electronic data interchanges (ED), Griffin’s company serves 90,000 providers and submits claims to more than 3,000 payers.

Griffin will share an insider’s perspective of the good, the bad, and the ugly of how payers are coping with 5010 claims. You’ll understand the essential elements to making your lab’s claims “clean and compliant” at first submission. You’ll also learn specific things to avoid, as well as how to quickly recognize payers with problems in their 5010 implementation program.

As you know, the 5010 form requires new information from providers that wasn’t included on form 4010. What these new requirements are-and how to interpret data that might be returned if there are problems with your submissions-will be critical for getting your lab claims  reimbursed without delays in the process.

Adding confusion about how and when to use the new 5010 form is that some payers aren’t ready to accept it. And those that are may not be equipped to handle the massive number of new forms, which will cause further delays in claims processing and payments. But the reality is that it’s your lab that is ultimately at risk for claims denials or delays. Not knowing the ins and out of the new form and how to use it correctly poses a considerable threat to your bottom line.

Despite the testing delays at CMS, there has been no delay in transitioning to the new form. CMS did announce a grace period on penalty enforcement through March, but some payers are still insisting on the 1/1/12 cutover. So it’s critical that your lab start using-and understanding how to use-form 5010 now.

To make sure you’re on top of the new form and aware of the problems that could seriously affect your revenue stream, you won’t want to miss the latest audio conference from THE DARK REPORT and, “HIPAA Form 5010 Implementation: Real-World Solutions to Ease the Transition from 4010 to 5010 and Avoid Reimbursement Delays.” Listen as two experts who have first-hand experience with the new form provide details on the best strategies for being in compliance with its use. You’ll get practical, real-world insights and advice based on the results of comprehensive testing in the last year.

Keep in mind that the initial testing covered the design of the new form, not the actual data. So providers can expect to encounter additional problems when they start using 5010 on January 1st. With almost three weeks of experience submitting live claims on the new form, both speakers will have new insights to share, including specific payer problems and what you can do to overcome them. This is truly up-to-the-minute information that will have a direct impact on how your lab can avoid potential problems that could result in significant reimbursement delays.

Flexibility is key to any successful transition to form 5010. Your lab needs to know in advance which payers are ready for the new forms and which ones aren’t. So if your lab hasn’t done significant testing with its payers, this audio conference is your chance to find out what’s working-and what isn’t-with many of the payers. You’ll learn about some of the biggest problems and how to make sure they’re fixed before you submit additional claims to those payers.

But some payers simply won’t be ready. So bottom line: Be prepared to send native 5010 and 4010 forms and decide which one to send on a payer-by-payer basis. And make sure you can revert to 4010 at a moment’s notice to ensure timely reimbursement.

Whether you work in a hospital, health system, or independent clinical laboratory-even if you use your hospital’s billing and collections department or an outside billing company-this is one session you can’t afford to miss.

Order today to get the latest on the new 5010 form, the changes you’ll need to make, the problems you can expect, and how it could all impact your revenue cycle management after the cutover.  And remember that your entire management team can learn and participate when you register.


COST: $245 per digital recording with materials

TO ORDER AUDIO NOW: Call 1-800-560-6363 toll-free

For one low price—just $245— you and your entire team can take part in this fast-paced, insightful audio conference. Best of all, you’ll be able to connect personally with our speakers when we open up the phone lines for live Q&A.

Here’s just some of what you’ll learn during this in-depth 90-minute audio conference recording:

  • The best and worst news for labs about the first 18 days of form 5010 implementation.
  • Common issues that prevent payers from prompt settlement of lab-test claims submitted on 5010 forms, plus what labs can do to rectify these problems.
  • Which payers are struggling the most with 5010 lab-test claims, plus the names of payers doing a great job processing 5010 claims.
  • Specific steps your clinical laboratory can and should do to address payer problems with form 5010 that will speed payment of conforming lab test claims.
  • What’s working (and what isn’t) in form 5010 implementation.
  • Simple steps to optimize your lab’s ability to submit clean claims and get timely/accurate payments.

…and much more!

How to Order Now:

1. Online
2. Call toll free: 800-560-6363.

Your audio conference registration includes:

  • A downloadable PowerPoint presentations from our speaker
  • A full transcript emailed to you soon after the conference

Order Audio and Materials Now!    Or for more information, call us toll-free at 800-560-6363

ACCENT® Continuing Education Credit
The American Association of Clinical Chemistry (AACC) designates this program for a maximum of 1.5 ACCENT® credit hours towards the AACC Clinical Chemist’s Recognition Award. AACC is an approved provider of continuing education for clinical laboratory scientists in the states of California, Florida, Louisiana, Montana, Nevada, North Dakota, Rhode Island, and West Virginia.

She is a member of DxMA, ASM and AMP and was a Microbiology Supervisor before transitioning to the diagnostic industry.”