Do You Know About the New Mandatory CMS-1500 Form?

Head’s up medical billers, by April 2007, it will be required that you start using the new CMS form that accommodates the new National Provider Identifier (NPI) numbers.

“Because of the number and types of changes that the new CMS-1500 includes, you will need to update your billing software programs to print your claims correctly”, says Cyndee Weston, executive director of the American Medical Billing Association. That means now is the time to update your billing system software to ensure your office is ready. If you don’t already outsource your medical billing claims and you don’t want to spend the money for an upgrade – it may be time to outsource your medical billing claims and avoid this expense.

The new form goes into effect on January 1, 2007. You will not be required to use the form for medical billing claims until April 2, 2007. So if you do choose to upgrade your medical billing software, you will have until that date to do so. Be aware that the form criteria applies to resubmitted medical billing claims as well as new claims submitted after April 2, 2007. If you have a claim that needed more documentation or information and you resubmit it after April 1, 2007; you will need to refile on the proper form as your old form will be outright rejected by all carriers after that date.

Transitions in software don’t have to be painful. Plan ahead and get your game plan going to make sure that your software vendor is able to accommodate the changes in your industry or consider outsourcing and completely forego the hassle of any upgrades and let a medical billing partner handle your claims – not only will you be giving up the paper chase and endless changes to keep up with – you’ll also realize faster reimbursement times on all your medical billing claims.

You can see the new CMS-1500 form at www.nucc.org/images/stories/PDF/final–1500–claim–form.pdf.

View all Articles by: Kathryn Etienne, CCS-P