MGMA: Doctors not ready for 5010, 'contingency plan' needed

The Medical Group Management Association (MGMA) has called for the Department of Health & Human Services (HHS) to create a contingency plan for the impending transition to the 5010 electronic transaction standards. MGMA would like HHS to allow health plans to adjudicate claims "that may not have all the required data content" after Jan. 1, 2012, when all claims must be sent in the 5010 format.

Commenting on the results of an association survey, Dr. Susan Turney, president and CEO of MGMA, said in a statement, "It is clear that a significant number of medical groups will not have the ability to transmit claims and other electronic transactions using the Version 5010 format by the Jan. 1 deadline. In particular, the study results highlight the fact that external testing with health plans is significantly delayed. It is imperative that HHS take immediate steps to ensure that practice operations are not compromised due to cash flow disruption."

MGMA urges HHS to encourage providers and health plans to concentrate strictly on the most critical data content requirements of the electronic claims and other transactions. If the claim contains the minimum content required for the health plan to successfully adjudicate the claim, HHS should not penalize health plans by requiring them to reject it, the association said. MGMA also would like Medicare to announce that minor errors in 5010 claims will not trigger an automatic rejection.

Among the key findings of the survey:

  • 77 percent of respondents said they'd heard from their software vendors about the transition to 5010.
  • 35 percent of respondents indicated that internal testing had begun.
  • Less than 6 percent of respondents said that all of their major health plans had contacted them about 5010, and only 35 percent reported that some of their major payers had contacted them.
  • 15 percent of respondents said external testing had started with all their major plans, and 15 percent said testing had begun with some payers.
  • 27 percent of respondents said external testing with payers had not yet been scheduled.
  • Asked about their contingency plans, about half of the respondents said they'd revert to paper claims, and one-third were planning to get a line of credit to cover their expenses if the 5010 transition disrupted their cash flow.

Perhaps most significant, just 4 percent of the respondents said their 5010 implementation was complete, just a little more than two months before the deadline. MGMA has been warning all year that physician practices might not be prepared for the 5010 switchover by Jan. 1. 

To learn more:
- read the MGMA press release