MGMA urges HHS to take immediate action on 5010-related payment delays


The Medical Group Management Association yesterday urged the U.S Department of Health and Human Services to take immediate action to help alleviate payment disruptions that have occurred due to the transition to HIPAA 5010.

“Should the government not take the necessary steps, many practices face significantly delayed revenue, operational difficulties, a reduced ability to treat patients, staff layoffs, or even the prospect of closing their practice,” wrote MGMA President and CEO Susan Turney, MD, in a letter to HHS Secretary Kathleen Sebelius.

In the letter, Turney detailed a long list of payment difficulties encountered by its member practices including:

  • claims rejected by Medicare Administrative Contractors (MACs) despite 5010 testing that showed no problems;
  • issues with secondary payers;
  • crosswalk NPI numbers not being recognized;
  • lost claims with MACs; and
  • sporadic payment of re-submitted claims.

According to MGMA, many of its members report long delays in receiving payments from the Medicare and TRICARE programs, with some practices not having been paid since November 2011 as a result of the 5010 issues.

In early November, amid reports that a broad number of providers would not be ready to meet the HIPAA 5010 compliance deadline of January 1, the Centers for Medicare & Medicaid Services announced that it would delay enforcement penalties until March 31.

Contending the system is not working and is choking the cash flow of many of its members, MGMA is recommending the enforcement deadline by extended another three months to June 30.

In addition to extending the deadline, MGMA is urging HHS to instruct the MACs to provide advance payments to practices that are struggling to meet the 5010 mandate and that it allow all covered entities to submit Version 4010 claims until at least June 30.

Other HHS actions recommended by MGMA:

  • Allow MACs and clearinghouses to accept and adjudicate Version 5010 claims even if they don’t include all of the required data content.
  • Instruct MACs to expedite adjudication of all existing claims, both paper and electronic.
  • Instruct MACs to adjudicate 5010 claims in batch mode.
  • Instruct MACs to provide adequate manpower to their call centers to ensure timely service.
  • Closely monitor readiness level in the industry and take any additional steps prior to and after June 30 to ensure timely payments to providers.

“It is imperative that HHS address these issues without delay,” Turney’s letter concluded. “We strongly urge the Department to put in place the steps necessary to ensure that claims will be paid in a timely manner so that practices can continue to keep their employees paid, and physicians providing care to the patients they serve.”

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