Historically in order to submit Medicare claims to the Center for Medicare & Medicaid Services hospitals, doctors and other healthcare service providers would be required to submit paper Form CMS-1500 if they are exempted from electronic submission requirement under Administrative Simplification Compliance Act.
While this form is consistent with the ANSI ASC X12 837P format used to submit electronic claims, using paper forms to submit claims is time consuming, burdensome and delays payment for services rendered. More and more, smaller healthcare providers such as private physicians, small pharmacies, medical device providers and the like are opting to switch to electronic submission to streamline their business, increase revenue flow and decrease payment delays.
As an increasing number of providers are recognizing the benefits of going paperless to running their business more effectively and switching to electronic submission a twin issue has arisen, leaving many small offices dropping paper claims back in the boat of slow payment turn-around. Specifically, all but two Medicare Administrative Contractors have dropped dial-up as an acceptable way of submitting electronic claims. In order to continue submitting claims providers will have to revert to paper forms, submit through the MAC's portal, pick up a billing vendor or clearinghouse to process claims on their behalf, or pick up a Network Service Vendor.
What is a NSV?
A NSV is an organization that provides CMS-approved connections between providers and MACs to enable electronic transmission of Medicare transactions. NSVs use secure Internet technologies to provide fast and cost-effective connections. The use of NSVs is increasing as more providers are able to format their own electronic transactions and wish to communicate directly with their MAC.
NSVs offer connections to important Medicare services such as:
• Claims for Medicare Part A, Part B, Regional Home Health Intermediaries and Durable Medical Equipment
• Direct Data Entry for Medicare Part A providers
• Professional Provider Telecommunications Network for Medicare Part B providers
• Claim Status Inquiry for DME suppliers
• Medicare beneficiary eligibility verification.
NSVs provide fast and reliable access to Medicare Fee for Service Contractors. Using an NSV can shield a provider from changes in Contractor connectivity and help ensure an uninterrupted revenue flow. Some NSVs offer value-added services such as commercial payer eligibility verification and claims submission. NSVs approved by each MAC are listed on the MAC's website.
The role of NSVs is expanding
As previously discussed, several factors are driving the growth of NSVs. Outdated technology like legacy connections using modems are increasingly difficult to maintain. Providers are looking to move from dialup to Internet connections. Improved Internet security is also a draw for providers. NSVs encrypt data for transmission across the Internet.
Additionally, MAC changes occur every five years, as CMS must put the regional Contractor business up for re-bid. This is mandated by law. When Contractors change, NSVs handle connecting to new Contractors so that providers do not have to change their connections.
Finally, providers looking for value-added services can find them with NSVs. Far from just allowing providers to submit electronic payments, customers can take advantage of other services that NSVs offer, such as commercial payer eligibility verification and claims submission.
Several events will drive the further growth of NSVs, including the next round of MAC changes that will be underway this year. Some Contractors may change, and providers who do not use an NSV will be impacted. All but two MACs do not support claims submission via dialup modems. The other two MACs are actively evaluating to drop dialup as dictated by old and unsupportable technology.
Transmission of claims using a NSV
Conclusion
Having already enumerated the issues with paper submission, the alternatives come with their own drawbacks. Using the MAC's portal, while free, only allows the provider to send one claim at a time in most cases. They also require enrollment and re-enrollment, which can take weeks, and are often difficult to integrate with practice management systems that providers may already be using. A billing vendor/clearinghouse streamlines the process but can be expensive to use, as they typically charge a licensing fee and either charge per claim or set a "ceiling" for claim submissions (e.g. "up to 2,000 transactions per year").
NSVs can offer a low-cost, secure and pain-free alternative when submitting claims electronically, and if the provider already has a submitter ID there is no need to get a new one. Some NSVs are only regional, making them impractical for organizations with multiple MAC jurisdictions, and some offer connection to only MACs for claims submission or DDE, not both. Still, for many healthcare organizations from solitary providers all the way up to statewide hospital networks a NSV is an attractive and cost effective way to submit claims quickly and securely to CMS.
About the author
Shig Kimoto, Executive Advisor of the RAPID Network for ECC Technologies, Inc. has over 30 years of healthcare experience with an extensive working relationship with providers, software/billing/clearinghouse vendors and CMS. Prior to joining ECC he was the Director of EDI at NGS where he directed all aspects of work performed at the EDI department while managing 200+ million claims annually into the NGS EDI Gateway. He was instrumental in starting the NSV movement in the late 1990s to promote electronic submission of Medicare claims.
The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.