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MGMA: HIPAA 5010 conversion causing payment headaches


Practices report widespread claims denials since adopting the HIPAA Version 5010 transaction standard, MGMA says. Learn more about the kinds of errors practices are seeing.

The new Health Insurance Portability and Accountability Act (HIPAA) transaction standard is causing practices major payment disruptions, according to a letter from the Medical Group Management Association (MGMA) to the Department of Health and Human Services (HHS).

In the letter, Susan L. Turney, MD, MS, FACP, FACMPE, MGMA president and chief executive officer, warns that “should the government not take the necessary steps, many practices face significant cash flow disruptions, operational difficulties, a reduced ability to treat patients, staff layoffs, or even the prospect of closing their practices."

Turney writes that groups’ claims are being rejected this year despite successful testing with HIPAA Version 5010 last year. Groups are facing rejections due to address errors, claims being lost by Medicare contractors, and national provider identifier numbers not being recognized.

Turney urges HHS Secretary Kathleen Sebelius to postpone the HIPAA Version 5010 enforcement date to June 30 from March 1. She also recommends that contractors advance payments to practices struggling to meet the new mandate.

“MGMA’s principle concern is, without immediate action from HHS and the Centers for Medicare and Medicaid Services to alleviate these issues, disruptions caused by Version 5010 will ultimately interfere with patient access to quality care,” Turney wrote. “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.”

Meanwhile, the certification committee leading the next HIPAA transaction standard, Version 6020, will not push for the newer version until issues with 5010 are resolved, according to a recent announcement from the group, ASC X12, a subsidiary of the American National Standards Institute.

“Even though the 6020 versions will not be recommended for adoption, it is critical that healthcare industry stakeholders review the 6020 [technical reports] currently posted for public comment and provide comments to ASC X12,” as they will become the basis for the next standard, according to a statement from the group.

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