Inside the 835: Part 2--Medicare Codes
By Caleb Dixon
Monday, October 16, 2006
Inside the 835: Part 2 – Medicare Codes
By
Caleb Dixon
, RemitDATA, Inc.
This is Part 2 of a series delving into some interesting happenings inside the 835 Electronic Remittances.
When implementing 835s from non-Medicare payers into your billing mix, you will find what appears to be a new set of denial codes. These “Medicare codes” are the standard ANSI denial and payment codes required to be utilized by any payer utilizing 835 Electronic Remittances. Historically, most payers implemented their own version of the National Standard Format that was unfortunately not standard between Medicare and non-Medicare payers. So, in the data, you had the same scenario that existed on the paper EOBs: payer specific denial codes. These codes have unique numbering schemes, definitions, and applications depending on which payer you are working with.
Many problems caused with such a disjointed system of posting payments and working denials are alleviated with the 835. Because of the 835 standard, all payers producing electronic remittances are moving towards congruency. No longer will you have Medicare codes, Medicaid codes, Blue Cross codes, and miscellaneous codes. You primary denial codes will be the same across all payers and you will utilize the reason and remark codes to get more specific adjudication information on individual claims. This allows you the option to remove the departmentalization of you billing staff by payer. You will also be able to auto-post your payments from these payers and begin tracking detailed key performance indicators. These efficiency improvements exist and are easy for you to capitalize on by simply implementing 835s from your largest payers.
Even if your billing system is not able to auto-post 835s, go ahead and get signed up to receive them. With the recent move by Medicare to no longer produce paper EOBs, we must assume that non-Medicare payers will follow suit. You can still glean valuable information from the 835 without auto-posting them, and will be ahead of the curve on implementation. If you are concerned about re-training your staff, many payers provide crosswalk tables to guide you in transitioning from the older payer specific codes to the new standardized codes.
You will be utilizing 835s from payers in the future, so why not go ahead and get started now? Please feel free to contact us if you have any questions regarding your next steps.