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HCFA Revised Effective April, 2014 – Are you Ready?

Mar 24th 2014 at 4:10 AM

In recent times, submitting claims in the electronic form has become more prevalent in the US healthcare space. However, we can see that several small practices and health insurance companies are still using traditional paper-based claims. Whether they use the electronic or the paper-based method, keeping the finger firmly on the pulse is essential as many medical reforms are being introduced lately. One such reform is the HCFA revision of CMS 1500 claim forms, which will come into effect on April 1st, 2014. It is mandated that Healthcare Facilities and Providers use the updated CMS 1500 or HCFA (as it is still popularly referred to) claim form to carry out their medical billing and collections.

CMS 1500 (HCFA) Claim Revision: The CMS 1500 claim form that is normally used to process medical billing and collections has been updatedwith new format spaces to accept the ICD-10 codes. It is done with regard to the ICD-10 implementation that is set to roll out on October 1st. Find below some of the preparation tips:

Know the Timeline: The revised HCFA 1500 claim has been officially termed as ‘Version 02/12’. With March 31st set as the deadline, Healthcare Providers and Facilities submitting claims on paper must make sure that their medical claims management systems are updated with the new form.

Buy Updated CMS 1500 (HCFA) Claim Forms: Healthcare Facilities and Providers who use paper-based claims need not buy the old CMS 1500 claim forms anymore as they are considered outdated, but have to buy the new CMS 1500 forms. The already existing forms can be cleared out by using them for medical billing and collection process before the stipulated deadline. From April 1st, Providers are expected to make use of the revised 1500 claim forms. Medicare has announced that it will strictly not accept old CMS 1500 claim forms, Version 08/05 after April 1st, 2014.

Learn the Changes Made: Before using the updated claim form, Healthcare Facilities and Providers must first learn what significant changes have been made in the new form:

· New indicators have been provided in the claim to distinguish between ICD-9 and ICD-10 codes.

· Qualifiers are included to set apart Providers and Healthcare Practices using ICD-9 and ICD-10 code sets to carry out medical billing and collections.

· Letters will be used as diagnosis code pointers instead of numbers.

· Expansion of ICD codes from 4 to 12 in the diagnosis field.

Healthcare Facilities and Providers must share this information with the physician practice management companies to whom they have outsourced their medical claims management processes. Providers who perform medical billing and collections in-house can get help from physician practice management companies to handle such healthcare changes. By doing so, they can keep themselves updated with the most recent developments.

About MGSI:

One of the most popular and reliable physician practice management companies, MGSI has its base on Florida. Having more than 20 years of experience in providing uncompromised physician billing solutions, this national billing company will help you through the transition of HCFA revision and ICD-10 implementation. To learn more details, log on to

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