Posted by: RedaChouffani
5010, HIPAA, HIPAA 5010, Medical Group Management Association, MGMA
Being a member of the North Carolina Medical Group Managers (NCMGM), I’ve recently had direct exposure to the many challenges the industry is facing around the HIPAA 5010 transition. Through round table discussions and list serve feedback from health care administrators, it is very clear that despite much of the testing done in 2011, challenges abound since the passing of the implementation deadline last month.
Unfortunately, these challenges are not faced by North Carolina provider organizations alone. The Medical Group Management Association (MGMA) received feedback on 5010 obstacles and pitfalls from provider organizations around the country. In response, the MGMA sent a letter to HHS Sec. Kathleen Sebelius describing the problems and reimbursement issues faced by many of those who have gone through the transition.
The letter cited several challenges encountered since implementing, including:
- Issues with practice management and/or billing systems that showed no problems during the testing phase with their MAC, but once the practice moved into production phase, found their claims being rejected
- Issues with secondary payers
- Rejections due to various address issues (pay-to address being stripped/lost from claims; Pay to address can no longer be the same as billing address; no PO Box address)
- Crosswalk NPI numbers not being recognized
- “Lost” claims with MACs
- Old submitter validation information not being transferred
- Certain “not otherwise specified” claims being denied due to not having a description on the claim (CMS sent a notice of correction of this issue Jan. 27, 2012)
- Sporadic payment of re-submitted claims (with no explanation for rejections)
- Protracted call hold times (most typically 1-2 hours) when attempting to contact
- MACs for further explanation of unpaid and rejected claims (a problem that dates as far back as November 2011)
- Unsuccessful claims processing (with no reason cited for rejection) despite using a “submitter” that was approved after successful testing with CMS
In the letter, the MGMA requests that the HHS considers delaying the enforcement of the rule, as well as provides advanced payments for physician practices who are struggling to meet the deadline in lieu of the simultaneous EHR meaningful use mandates and the compounding stress on capital.