Updated on: March 17, 2016

MGMA Calls for Slowdown to 5010

Original story posted on: December 21, 2011

Less than two weeks prior to the mandated implementation date of HIPAA Version 5010, the Medical Group Management Association (MGMA) is asking the Centers for Medicare & Medicaid Services for a six-month “contingency plan” allowing health plans to continue to accept 4010 transactions for a limited period of time, according to an announcement made this week in a news release posted on the MGMA website.


On Dec. 14 Medicare announced that “submitters/receivers” that had tested and been approved for 5010/D.0 would be notified that they would have 30 days to switch to the 5010/D.0 versions. In the announcement Medicare stated that those that had not yet tested would be notified that they must submit their transition plans and timelines to their respective MAC in 30 days. 


“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,” said Susan Turney, MD, MS, FACP, FACMPE, MGMA-ACMPE president and CEO, in the MGMA news release. “HHS should immediately allow physician practices to continue submitting Version 4010 transactions.”


“The 90-day moratorium provides the type of relief that MGMA is asking for,” said Stanley Nachimson, principal of Nachimson Advisors, LLC, in a written statement to ICD10monitor. “On a voluntary basis, health plans can accept 4010 transactions and ‘incomplete’ 5010 transactions during the moratorium without fear of a noncompliance penalty. Providers should take these 90 days to complete system testing and (ensure) that they can transact business using the 5010 transactions. And they should be reminded that they (and health plans) are subject to CMS action if they do not comply.”


Citing studies MGMA has been conducting by querying its members, Turney said only 32 percent of respondents reported that their organizations' practice management system software was upgraded to the HIPAA Version 5010 standards and that internal testing was complete. Nearly 25 percent indicated either that their software has not been upgraded or that testing is not even scheduled.

"We have been tracking the Version 5010 coordination between physician practices and their key trading partners throughout 2011, and it is clear that a significant number of these stakeholders are not ready to meet the Jan. 1 compliance date,” Turney said. “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. HHS should immediately allow physician practices to continue submitting Version 4010 transactions.”


Nachimson acknowledged that a “significant” number of practices are not ready to transition to 5010 by Jan. 1, 2012, based on MGMA surveys and other reports he has read.


“This is disturbing, as the industry has been aware of the need to transition since the requirement was published in January 2009,” Nachimson said. “Many surveys over the past year indicated that the industry has been behind recommended timelines for meeting the compliance date.”


“With the large number of practices reporting that they will revert back to paper claims, we are concerned about the potential delay in adjudicating the large volume of paper claims,” Turney added. “Further, the serious challenges in meeting the Version 5010 mandate and the need for a comprehensive contingency plan from HHS call into question the ability of the industry to transition to ICD-10 by the Oct. 1, 2013 compliance deadline.”


“The reality of the situation is that we must get the industry on the new standards so that work can begin on ICD-10 implementation and other important efforts,” Nachimson said. “Further delays beyond the 90-day enforcement moratorium already granted by CMS will cause irreparable harm to ICD-10 and other improvement efforts.”

Chuck Buck

Chuck Buck is the publisher of ICD10monitor and is the executive producer and program host of Talk Ten Tuesdays.