MGMA to HHS: Delay 5010 enforcement

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The mandated Jan. 1 conversion to a new set of electronic claims transaction standards is not going smoothly for office-based physicians, disrupting medical groups' cash flow and creating hassles, according to the head of the Medical Group Management Association (MGMA)-American College of Medical Practice Executives (ACMPE).

In a three-page letter to Health and Human Services (HHS) Secretary Kathleen Sebelius, MGMA President and CEO Susan Turney, MD, listed eight steps HHS needs to take to fix problems that began arising before the Jan. 1 deadline HHS set for national compliance with federally mandated use of the ASC X12 Version 5010 standards.

"Should the government not take the necessary steps," Turney warned, "many practices face significant delayed revenue, operational difficulties, a reduced ability to treat patients, staff layoffs or even the prospect of closing their practice."
HHS announced in November it would keep in place the Jan. 1 compliance deadline for the 5010 conversion, but would grant a 90-day abeyance of enforcement of its new rule.

One of Turney's eight recommendations is to push that enforcement delay even further back, to June 30.

In addition to asking for the deadline extension, MGMA requested that the Centers for Medicare & Medicaid Services:

  • Instruct Medicare carriers to make "advance payments" to physicians struggling to submit 5010 claims.
  • Permit clearinghouses and health plans to accept and adjudicate 5010 claims that do not have all of the required data content, but that have sufficient data content to be successfully adjudicated.
  • Order Medicare carriers to adjudicate claims more quickly, accept claims in batch mode, and answer provider questions in a timely manner.

Turney said problems are being reported "with Medicare Administrative Contractors (MAC) and commercial plans." Some glitches that surfaced after Jan. 1 went undetected during systems testing before the deadline, she said. Meanwhile, help lines at MAC contractors have been swamped, Turney said.

The letter is available in its entirety.