MGMA calls for 5010 contingency plan due to rampant unpreparedness

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Many practices are lagging behind in implementing software upgrades or testing health plans in advance of the transition to the new HIPAA Version 5010 electronic transaction standards prompting the Medical Group Management Association (MGMA) to call on the Department of Health and Human Services (HHS) to immediately issue an expanded contingency plan.

Research has indicated that many state Medicaid plans will be unable to accept Version 5010 claims, according to the Englewood, Colo.-based association for medical professionals. MGMA advised that the new contingency measures should go beyond HHS’ Dec. 14 announcement and should permit health plans to continue accepting HIPAA Version 4010 transactions and adjudicate Version 5010 claims that lack all the required data. This contingency plan should last for a minimum of six months, according to MGMA.

HHS announced that in December, practices and plans that have tested and been approved for Version 5010 will be notified they have 30 days to transition to the new claims format. Practices that have not yet tested with the Medicare Administrative Contractor (MAC) will be notified they must submit a transition plan and timeline to their MAC in 30 days.

“Our main concern is that the failure to implement Version 5010 by the compliance date will impact payment to practices for the services they provide,” said Susan Turney, MD, MGMA-ACMPE president and CEO. “We oppose requiring the submission of a transition plan and timeline as a needless bureaucratic exercise that adds to the workload of the providers who have to produce them and the government employees who have to review them. HHS should immediately allow physician practices to continue submitting Version 4010 transactions.”

MGMA also released a list of key findings from their research:

  • Just two weeks away from the Jan. 1 deadline, only 13.9 percent of respondents rated their 5010 implementation status as fully complete.
  • Only 32 percent of study respondents reported their organizations' practice management system software has been upgraded to the HIPAA Version 5010 standards and that internal testing has been completed.
  • Just 32 percent of respondents said testing is complete with their Medicare contractors. Additionally, almost one quarter (22 percent) reported they have not scheduled testing with their Medicare contractors.
  • Less than a quarter (17.9 percent) of respondents said they have completed testing with their Medicaid plans.
  • Seventy-nine percent of study respondents indicated that testing with all major commercial health plans remains incomplete. Almost one quarter (23.5 percent) reported that testing is still not scheduled with any major commercial health plans.
  • Study respondents were asked about their contingency plans following the Jan. 1 compliance date. Almost one quarter (23 percent) reported that they plan to revert to paper claims in an attempt to avoid cash flow issues.