The Medical Group Management Association recently sent a letter to Department of Health and Human Service Secretary Kathleen Sebelius, saying that if the government does not rectify the current problems with the transition to HIPAA Version 5010 electronic transaction standards, physician practices may face "significant cash flow disruptions, operational difficulties…or even the prospect of closing their practices."
MGMA listed several frequently reported problems in the move to Version 5010:
• Issues with practice management and/or billing systems. The systems allegedly showed no problems during the testing phase with the practice's Medicare Administrative Contractor, but claims are now being rejected.
• Issues with secondary payors.
• Claims rejections due to various address issues (e.g., pay-to address is not the same as the billing address, no P.O. box address, etc.).
• "Lost" claims with MACs.
• Old submitter validation information not being transferred.
MGMA consequently wrote that HHS needed to take eight action steps, including:
• Instruct MACs to provide immediate advance payments for physician practices that are struggling to meet the Version 5010 mandate.
• Extend the enforcement delay from March 31, 2012, to at least June 30, 2012.
• Allow all covered entities to submit and accept Version 4010 claims until at least June 30, 2012.
• Permit clearinghouses and health insurers to accept and adjudicate Version 5010 claims that do not have all of the required data.
• Issues with practice management and/or billing systems. The systems allegedly showed no problems during the testing phase with the practice's Medicare Administrative Contractor, but claims are now being rejected.
• Issues with secondary payors.
• Claims rejections due to various address issues (e.g., pay-to address is not the same as the billing address, no P.O. box address, etc.).
• "Lost" claims with MACs.
• Old submitter validation information not being transferred.
MGMA consequently wrote that HHS needed to take eight action steps, including:
• Instruct MACs to provide immediate advance payments for physician practices that are struggling to meet the Version 5010 mandate.
• Extend the enforcement delay from March 31, 2012, to at least June 30, 2012.
• Allow all covered entities to submit and accept Version 4010 claims until at least June 30, 2012.
• Permit clearinghouses and health insurers to accept and adjudicate Version 5010 claims that do not have all of the required data.
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9 Things Healthcare Organizations Should Do Now to Prepare for ICD-10