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Otolaryngology Coding Alert

Stop Rushing to Switch Over to the New CMS-1500

CMS gives you a breather due to incorrect forms

Don't discard your old CMS-1500 forms just yet.

The Centers for Medicare & Medicaid Services granted you a respite and will allow the old version (12-90) possibly until June. You originally had to change over from the old version (12-90) by April 1. Medicare contractors were then to accept only the revised version (08-05), which accommodates the National Provider Identifier (NPI) number.

Medicare extended the deadline in response to recent circumstances. 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 in Sulphur, Okla. -I am doubtful that some software vendors would have been ready by April 1,- she adds.

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 Medicare notice released March 9, 2007. Identify Your Form With These Marks Submitting incorrect versions of the revised version will delay payments. Your carrier will not key in a claim using an incorrectly formatted version and will instead return it to you. This protocol will -make you aware of the situation, which will allow you to begin communications with your form supplier,- Reitz says.

Beat your carrier to the punch and get your claim processed on initial receipt by making sure you-re not using incorrect forms. Here's how to identify which form is which and when each is valid:

Prevent Returns by Spotting This Problem To find out if your CMS-1500 version 08-05 is bound to be returned, look at the upper right-hand 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.

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