Updated on: March 17, 2016

MGMA Tells HHS to Fix Payment Delays and Extend 5010 Enforcement

Original story posted on: February 2, 2012

In the second of two salvos directed at the federal government’s mandated implementation of ICD-10 and HIPAA Version 5010, the Medical Group Management Association demanded this week that the U.S. Department of Health and Human Services correct disruptions to physicians receiving payments, a result of the new electronic transmission set. MGMA also called for an extension of the enforcement delay of March 1, 2012 to June 1, 2012.


The earlier salvo came when a letter from James L. Madara, MD, executive vice president and CEO for the American Medical Association, to U.S. House of Representatives Speaker John Boehner was released last week. In the Jan. 17 letter, Madara urged Congress to halt implementation of ICD-10 by October 2013.

Then on Tuesday, in a letter to U.S. Health and Human Services Secretary Kathleen Sebelius, MGMA President and CEO Susan Turney, MD, wrote that physician practices "have reported numerous problems across various areas of the United States stemming from the transition to Version 5010," citing problems with secondary payers, rejections due to various address issues and crosswalk NPI numbers not being recognized. Previously, just two weeks before the Dec. 31, 2011 deadline to implement 5010, Turney asked 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.

This time around, in her letter to Sebelius, Turney noted that many of her association’s members reported having not been paid by Medicare and TRICARE since November 2011 as a result of using 5010. Turney also offered what she described as an "action step" HHS should take to mitigate the problems, including calls on MACs to "immediately provide advance payments for physician practices" struggling to meet the 5010 mandate.

Among Turney’s seven other recommended "action steps" are the following:

No. 4: Permit clearinghouses and health plans to accept and adjudicate Version 5010 claims that do not have all of the required data content, but still have sufficient information.
No. 5: Instruct the MACs to expeditiously adjudicate all outstanding claims, both electronic and paper.
No. 6: Instruct the MACs to take all appropriate steps to ensure that they can accept and adjudicate Version 5010 claims in batch mode.
No. 7: Instruct the MACs to take all appropriate steps to ensure that call centers are manned appropriately and that they are able to answer incoming provider questions in a timely manner.

In agreeing with recommendation No. 4, saying it is "something that can be done now (and probably is being done in certain cases) and should probably continue until March 31," Stanley Nachimson, founder of Nachimson Advisors, LLC said he would certainly support recommendation Nos. 5, 6, and 7 as well, noting that "Medicare and other health plans should plan for and support short-term transitions."

Nachimson added, however, that he couldn’t accept Turney’s demand for an extension to June 1, 2012.

"I do not believe an additional extension to the enforcement moratorium is necessary or advantageous," Nachimson wrote. "Practices and plans should be working through these issues, and I would say that most will be resolved before March 31."

Nachimson also suggested that the date should be used to "put pressure on health plans, vendors and providers to resolve the issue."

On the other hand, Dennis Flint, president of Complete Practice Resources, said the extension is indeed necessary, agreeing with MGMA.

"It is now February, and we are seeing numerous payers who are claiming 5010 compliance yet have not issued payments, EOBs or claims status since Jan. 1, 2012," Flint said. "Clearly, there is a difference between claiming 5010 compliance and actually being 5010-compliant. I doubt another 60 days of waived enforcement is going to change anything. The deadline needs to be pushed back."

Noting that further delaying 5010 enforcement may be a distraction to implementing ICD-10, Chris Powell, president of Precyse, said "it is critical that organizations aggressively pursue 5010 compliance without further delay so we can forge ahead and contribute to the reengineering of our healthcare system, creating a better healthcare environment for all."


Related Stories:

AMA to Congress: Halt ICD-10

5010 Conversion Study: Disappointing, but Hopeful

MGMA Calls for Slowdown to 5010

Chuck Buck

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