MGMA wants 5010 delay expanded due to practice unreadiness

With a majority of physician practices still unprepared for the impending transition to the government-mandated 5010 transaction set for electronic transactions, the Medical Group Management Association (MGMA) has called on the Centers for Medicare & Medicaid Services (CMS) to postpone the Jan. 1 deadline for at least six months.

Not long ago, CMS announced it would not enforce the use of the 5010 set until the end of March, although it expected healthcare providers to make good-faith efforts to comply with the requirement. 

All year, MGMA has been signaling that its members--medical groups including three or more physicians--would not be ready for 5010 by January. In its most recent survey, the trade association found that only 14 percent of practices had completed their preparations for the transition from the 4010 to the 5010 transaction set.

In contrast, most hospitals are ready. One reason is that 10 hospital information systems vendors supply the bulk of hospital financial systems, and those companies have been proactive about preparing for 5010. Hundreds of practice management system vendors serve physician practices; many of those firms have not yet upgraded their customers' systems. Only 32 percent of the respondents to the MGMA survey said their software had been upgraded and that internal testing was complete.

External testing of the new software with payers also is far behind schedule. MGMA reports that only 18 percent of practices have completed testing with states Medicaid programs either because the tests haven't been scheduled or because the states are not ready to accept claims in the 5010 format. Seven state Medicaid programs, including that of California, are not taking 5010 claims, MGMA says.

Meanwhile, almost a quarter of respondents said they had not yet scheduled testing with either Medicare contractors or commercial plans.

A similar percentage of practices said that unless CMS delayed the 5010 implementation, they would be forced to revert to paper claims to avoid cash flow problems. Many other practices are relying on clearinghouses to put their claims through--a process that worked imperfectly during the transition to the 4010 set several years ago.

Susan Turney, MD, president and CEO of MGMA, said that the slow transition to 5010 raises questions about the ability of the industry to adopt the ICD-10 diagnostic code set by Oct. 1, 2013. The 5010 transaction set is a prerequisite for the implementation of ICD-10.

To learn more:
- read the MGMA press release
- see the KLAS announcement about providers' 5010 plans 


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