Your Y2K to-do list should focus on carriers

Most providers haven’t tested claims process

If you have yet to do so, contact your carrier and arrange a test of your ability to submit an electronic claim dated in the year 2000. Otherwise, you may be in for a rude wakening on New Year’s Day.

As of late September, less than 2% of all provi ders had conducted Y2K claims readiness tests with their payers. Of these, 10%-30% of test claims flamed out because of improperly followed instructions, vendor billing software failures, or submitter hardware or software problems.

In turn, experts say group practices are more vulnerable than they realize to a Y2K meltdown — and resulting scheduling and cash flow problems.

Carriers, HMOs vulnerable too

On the flip side, the General Accounting Office (GAO) reports only about half of Medicare carriers have completed their own internal Y2K compliance testing. Additionally, only four of 424 HMOs were fully Y2K-compliant, and more than three-quarters of the contingency plans sent to Medicare by HMOs required significant changes. This revelation has prompted HCFA to demand managed care participants to recertify their Y2K readiness.

The GAO also says some areas were still unprepared to administer federal programs as of late September. According to the watchdog agency, Kentucky, Oregon, Nevada, South Carolina, Missouri, West Virginia, Oklahoma, Georgia, and the District of Columbia are all at "considerable risk" for Y2K failures in the area of administering Medicaid and children’s health insurance.

HCFA’s own internal computer systems seem to be on schedule to accept year 2000 claims and institute fee schedule changes. However, remember that even if nothing major goes wrong, HCFA still plans to place a two-week hold (Jan. 1-16 ) on initial year 2000-dated claims and fee schedule increases to allow for potential problems.

In turn, practices should figure on claim payments running from two to four weeks behind their normal processing cycle during this period and plan their cash and payroll needs accordingly.

Tip: Get all your 1999 claims in before the end of the year to avoid getting caught in the Jan. 1-16 holding pattern.