Formatting Error Trips Up Printing Office, Delays Deadline

CMS has postponed its April 1 deadline requiring care providers and suppliers -- including family physicians -- to begin using the new CMS-1500 claim form to submit paper claims to public or private payers.

A formatting error that affects the printing process is to blame.

According to a CMS bulletin, forms that were printed by the Government Printing Office, or GPO, do not comply with form specifications, causing critical information contained on the form -- such as the patient's name -- to appear outside the intended field when read by the scanning technology.

Because it is unclear whether forms produced by other print vendors are affected, family physicians should take a look at any stock of new CMS-1500 forms (version 08-05) they have purchased.

According to information on the CMS Web site, (PDF file: 1 page / 4 KB. More about PDFs.) "The best way to identify if your CMS-1500 (08-05) version forms are correct is by looking at the upper right hand corner of the form. On properly formatted claim forms, there will be approximately a one-fourth inch gap between the tip of the red arrow above the vertically stacked word "CARRIER" and the top edge of the paper. If the tip of the red arrows is touching or close to touching the top edge of the paper, then the form is not printed to specifications."

It's important to note that CMS has directed Medicare carriers to return any claims filed on flawed CMS-1500 forms to providers and suppliers. Accordingly, until a revised deadline for implementation of the new form has been established by CMS, Medicare carriers will accept the old CMS-1500 form (version 12-90).

"By returning the incorrectly formatted claim forms back to you, we are able to make you aware of the situation which will allow you to begin communications with your form supplier," said CMS in information posted on its Web site.

The GPO has not yet determined the turnaround time for replacing customers' CMS-1500 forms.

The CMS-1500 form was revised, in large part, to accommodate the 10 digits that make up the National Provider Identifier, a provider-unique identifying number that individual health care professionals must begin using on May 23. At this time, CMS said, the May NPI deadline remains unchanged.