Optometry Insurance: Important Information About The CMS 1500 Form

Posted by Janelle Pauli on Tue, Apr 08, 2014 @ 11:04 AM

We have some information from Emdeon that we'd like to share with you
regarding optometry optometry insuranceinsurance, changes to the new CMS 1500 form, and the ICD-10 delay. We know each of these topics can be confusing, especially lately, so we hope this will clear up a few of your questions.

There are two critical things you need to know about the new CMS 1500 form:

  • We can now accept claims uploaded using the new form. However, you must work with us to update your account settings before you switch to the new form.
  • There is no urgent need to upgrade to the new form related to the CMS April 1 deadline. You will need to upgrade your print image output to accomodate ICD-10 codes in advance of the 2015 deadline, but the April deadline has no relevance for claims submitted through us. 

All the changes and deadlines can be confusing and hard to keep track of, but the most important things for you to understand are that we support the new form, but you don't need to switch to the new form right now, and anytime you make a change to how you send your claims you must work with us to change your account settings.

Your Optometry Insurance Questions Answered

What is the April 1st CMS deadline?

As of April 1st, any claims that are delivered to CMS by mail must utilize the new version of the CMS 1500 form.

optometry insuranceDoes the April 1st deadline impact me?

If you submit all of your claims through VisionWeb, the April 1st deadline should have no impact on you. Any claim you submit though, regardless of what form you send it to us in, will be converted to a discrete, electronic format (ANSI X12 5010) before being submitted to the payer. Since the payer receives the claim in an electronic format, not a print image format, the print form utilized by you to create the claim originally is irrelevant. Note that even for the few payers where we don't have a direct connection for electronic submission, our process for printing and mailing claims to those payers will output your data on the new form. However, if you print a fraction of your claims directly from your practice management system and mail them yourself to a payer, then you will need to upgrade to the new form before submitting any additional claims by mail.

Do I need to upgrade to the new CMS 1500 form, ever?

Possibly not. The most obvious change in the new form is that it will allow you to send a larger number of diagnosis codes and will support submission of the longer ICD-10 codes. However, if your practice management system will allow you to output ICD-10 codes on your existing print image form, we can configure your account to read ICD-10 codes on that old form, which will reduce the need for you to upgrade to the new form. There are a number of issues you should consider regarding ICD-10 and your practice management system. You might need to upgrade to a new practice management system that supports ICD-10.

  • Does your practice management system support ICD-10 codes or otherwise allow you to enter ICD-10 codes? If not, you will need to upgrade your system before the October 2015 deadline.
  • Because ICD-10 codes contain more characters than ICD-9 codes, your practice management system may be unable to output the entire code. If this is the case, you'll need to upgrade.
  • Because ICD-10 codes are significantly more specific than ICD-9 codes you may need to include more diagnoses with your claim then you've used in the past. If your practice is such that you are likely to need more than eight ICD-10 codes, you will need to upgrade to the new form, which supports a larger number of codes.
  • On a related note, the old CMS 1500 form supports only four diagnosis fields. If you find that you need more than four codes, we can support an additional four fields output to other places on the form, but diagnoses five through eight will only be available to you if your practice management system provides a consistent way to include them somewhere on the old form.

What do I need to do if I want to send ICD-10 codes on my current CMS 1500 form, rather than upgrading my CMS 1500 form?

Before you begin sending ICD-10 codes you must contact us to make a minor change on your account. We recommend that we coordinate this change to occur ahead of when you actually being sending ICD-10 codes. We provide the option for you to include information in your claims that states whether diagnosis codes are ICD-9s or ICD-10s. This is useful, but not critical, if we reconfigure your system for ICD-10 support in advance of the date on which you being sending ICD-10 codes. If you're not able to provide the code type, we will assume that the diagnosis codes you are sending are ICD-9. The more compelling need for inclusion of the code type information comes in the event that certain claims for service after the deadline fall within some type of yet-undefined exemption requiring use of ICD-9 codes. The code type qualifier provides support for handling any such exception, should the need arise.

If you have any questions regarding CMS 1500 or ICD-10 feel free to contact our insurance team at 800.590.0873, or email at sales@visionweb.com! And, if you want to get the latest optometry insurance information straight to your inbox, subscribe to the blog! 

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Tags: Electronic Claim Filing, ICD-10

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