MGMA Executive Urges HHS To Address HIPAA 5010 Challenges

Susan Turney -- president and CEO of the Medical Group Management Association -- has sent a letter urging HHS Secretary Kathleen Sebelius to address challenges associated with the conversion to HIPAA 5010 transaction sets, Modern Healthcare reports (Conn, Modern Healthcare, 2/2).


HIPAA 5010 standards regulate the transmission of certain health care transactions among hospitals, physician practices, health plans and claims clearinghouses. Converting to the HIPAA 5010 standards is seen as key to the larger switch from the ICD-9 clinical coding system to the ICD-10 system.

In November 2011, CMS announced it would wait until March 31, 2012, to begin enforcing compliance with HIPAA 5010 standards. However, CMS noted that the compliance date would remain Jan. 1, 2012.

In December 2011, MGMA urged CMS to delay the Jan. 1, 2012, compliance date for new HIPAA 5010 electronic transaction standards until June. MGMA cited a survey of its members finding that a significant number of stakeholders are not ready to use the HIPAA 5010 transaction sets (iHealthBeat, 12/21/11).

Challenges Associated With 5010 Conversion

In her letter, Turney noted that MGMA members working to comply with the HIPAA 5010 standards have faced numerous challenges, such as those involving:

  • Issues with secondary payers;
  • Medicare administrative contractors losing or rejecting claims; and
  • Sporadic payment of re-submitted claims (Anderson, Healthcare Finance News, 2/2).

Turney said that if the government fails to address such challenges, physician practices will "face significant delayed revenue, operational difficulties, a reduced ability to treat patients, staff layoffs or even the prospect of closing their practice" (Modern Healthcare, 2/2).

Recommendations to CMS

In addition, Turney reiterated MGMA's earlier request that CMS delay enforcement of the HIPAA 5010 standards until June 30. The letter asked CMS to:

  • Allow health plans and clearinghouses to accept and accept incomplete 5010 claims as long as they contain enough data to be adjudicated;
  • Order Medicare carriers to adjudicate claims quicker; and
  • Require Medicare providers to issue advance payments to physicians struggling to submit 5010 claims (Terry, FierceHealthIT, 2/2).

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