MGMA urges HHS to issue HIPAA 5010 contingency plan
Medical Group Management Association (MGMA) research on the transition to the new HIPAA Version 5010 electronic transaction standards indicated a need for the Department of Health and Human Services (HHS) to immediately issue a comprehensive contingency plan permitting health plans to adjudicate claims that may not have all the required data content.
The Englewood, Colo.-headquartered organization’s research suggested that critical coordination among many practices and their trading partners has not yet occurred. “Practices that do not successfully implement Version 5010 by the Jan. 1, 2012, compliance date face possible disruption in cash flow,” it continued.
Only about three-quarters (76.8 percent) of study respondents have heard from practice management system software vendors regarding the transition to 5010, and only 35 percent of respondents indicated that internal testing has begun, the report found. Additionally, 21.7 percent of respondents reported that internal testing with their practice management system vendor has not yet been scheduled.
“Just 5.7 percent of respondents indicate that all their major health plans have contacted them, and just 35 percent of respondents report that some of their major health plans have contacted them,” the report continued. “Only 15 percent of those surveyed reported that external testing has started with all of their major health plans, and 15.3 percent reported that testing had started with some of their major health plans. Twenty-seven percent reported that external testing has not yet been scheduled.”
Physician practices were asked about their contingency plans following the Jan. 1 compliance date. More than a third expected to establish a line of credit at a local financial institution; 35.6 percent were planning on setting aside cash reserves to sustain operations and more than half (50.6 percent) reported that they planned to revert to paper claims in an attempt to avoid cash flow issues, according to the report.
Additionally, only 4.5 percent rate their 5010 implementation status as fully complete, 50 percent rate it as between 26 and 99 percent complete and 40 percent of surveyed practices report their current implementation status as less than one-quarter complete.
MGMA urged HHS to encourage providers and health plans to concentrate strictly on the most critical data content requirements of the electronic claims and other transactions. “If the claim contains the minimum content required for the health plan to successfully adjudicate the claim, HHS should not penalize health plans by requiring them to reject it,” MGMA concluded. “Medicare should take the lead and announce that minor errors in the claim will not trigger an automatic rejection. More stringent adherence to the data content requirements can come after the vast majority of covered entities have adopted the Version 5010 formats.”
The Englewood, Colo.-headquartered organization’s research suggested that critical coordination among many practices and their trading partners has not yet occurred. “Practices that do not successfully implement Version 5010 by the Jan. 1, 2012, compliance date face possible disruption in cash flow,” it continued.
Only about three-quarters (76.8 percent) of study respondents have heard from practice management system software vendors regarding the transition to 5010, and only 35 percent of respondents indicated that internal testing has begun, the report found. Additionally, 21.7 percent of respondents reported that internal testing with their practice management system vendor has not yet been scheduled.
“Just 5.7 percent of respondents indicate that all their major health plans have contacted them, and just 35 percent of respondents report that some of their major health plans have contacted them,” the report continued. “Only 15 percent of those surveyed reported that external testing has started with all of their major health plans, and 15.3 percent reported that testing had started with some of their major health plans. Twenty-seven percent reported that external testing has not yet been scheduled.”
Physician practices were asked about their contingency plans following the Jan. 1 compliance date. More than a third expected to establish a line of credit at a local financial institution; 35.6 percent were planning on setting aside cash reserves to sustain operations and more than half (50.6 percent) reported that they planned to revert to paper claims in an attempt to avoid cash flow issues, according to the report.
Additionally, only 4.5 percent rate their 5010 implementation status as fully complete, 50 percent rate it as between 26 and 99 percent complete and 40 percent of surveyed practices report their current implementation status as less than one-quarter complete.
MGMA urged HHS to encourage providers and health plans to concentrate strictly on the most critical data content requirements of the electronic claims and other transactions. “If the claim contains the minimum content required for the health plan to successfully adjudicate the claim, HHS should not penalize health plans by requiring them to reject it,” MGMA concluded. “Medicare should take the lead and announce that minor errors in the claim will not trigger an automatic rejection. More stringent adherence to the data content requirements can come after the vast majority of covered entities have adopted the Version 5010 formats.”