MGMA calls for HIPAA 5010 transition strategy

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In a testimony before the National Committee on Vital and Health Statistics (NCVHS) Subcommittee on Standards last week, the Medical Group Management Association (MGMA) called for a federal strategy to ensure providers and trading partners are prepared for the transition to Version 5010 of the HIPAA electronic transaction standards.

“Should providers not be ready and experience wide-scale rejection of claims, practice operations and patient access to care could be negatively impacted,” the MGMA warned.

In late May and early June, the MGMA surveyed more than 350 practice administrators, representing organizations where more than 10,000 physicians practice medicine. The research showed that the vast majority of practices are aware of the Version 5010 mandate, but very few are ready to make the transition, the association stated.

To smooth the industry transition to Version 5010, MGMA urged the NCVHS to make the following recommendations to the Centers for Medicare & Medicaid Services (CMS):

  • Expand the tracking of implementation status and educational outreach to all impacted stakeholders, with particular emphasis on the vendor and provider communities.
  • Disseminate results from the June 15 Medicare national testing day, including any data content problems or issues.
  • Leverage summer/fall/winter provider association meetings and conduct outreach directly to the audiences at these meetings.
  • Publish a concise set of 4010 to 5010 changes for all effected stakeholders, "particularly providers who will have to potentially make the data content changes manually to ensure that they have submitted compliant claims."
  • Expand the August Medicare national testing day and encourage commercial plans and clearinghouses to participate.
  • Identify an additional national testing day in late fall and again encourage commercial plans and clearinghouses to participate.

Finally, the CMS should, based on survey data and results from national testing days, develop, at a minimum, a data content-based contingency plan. The focus of this contingency plan should be on permitting health plans to accept claims that do not contain all of the required Version 5010 data content.

The lack of readiness among practices is a concern, according to the MGMA. “A significant number of physician practices continue to wait on their practice management system software vendor to install the appropriate upgrade or replacement. We are also concerned about the cost incurred by those practices that are required to pay for the upgrade or replacement,” said the association.

“Finally, we are alarmed by the lack of communication from health plans regarding Version 5010 external testing,” the organization stated. As of early June, few practices had instituted external testing, which could lead to a backlog of test requests in the last few months of the year. This in turn could result in practices “going live with their Version 5010 transactions without having the ability to submit test transactions with their health plans.”

Click here to read the MGMA's testimony.