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

The Medical Group Management Association on Wednesday 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. 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.