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MGMA to Sebelius: Extend HIPAA 5010 Enforcement

February 2, 2012
by Gabriel Perna
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The Englewood, Colo.-based Medical Group Management Association (MGMA) has sent a letter to the Department of Health and Human Services (HHS) Secretary Kathleen Sebelius regarding their concerns about the disruptions to payments as part of the federally mandated transition to the Health Insurance Portability and Accountability Act (HIPAA) Version 5010 electronic transaction standard.

In the letter, MGMA’s president and CEO, Susan Turney, outlined a number of issues that medical groups are having with the transition. There are issues, she says, with practice management and/or billing systems that showed no problems during the testing phase with their

 Medicare Administrative Contractors (MACs), but once the practice moved into production phase, found their claims being rejected. There are also problems with secondary payers, rejections due to various issues and lost claims with MACs.

"MGMA’s principle concern is, without immediate action from HHS and the Centers for Medicare & Medicaid Services (CMS) to alleviate these issues, disruptions caused by Version 5010 will ultimately interfere with patient access to quality care. As the transition to Version 5010 is a mandatory step toward ICD-10 implementation, this raises even more concerns, given that ICD-10 is exponentially greater than Version 5010,” Turney added.

In the letter, Turney outlined several steps HHS could make to fix these issues. The number one request is that the enforcement Jan. 1 deadline be pushed back until June 30 of this year. HHS in November announced that while they were keeping the deadline for Jan. 1, they put a 90-day hold on enforcement of its new rule.

Turney also recommended HHS, “Closelymonitor the readiness level of the industry and take additional steps as needed prior to and after June 30, 2012 to ensure that transactions continue to flow and that physicians are paid.”



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