The Medical Group Management Association has sent a letter to HHS Secretary Kathleen Sebelius outlining significant problems with federal reimbursement of claims following the transition to the HIPAA 5010 transaction sets.

MGMA urges HHS to instruct Medicare Administrative Contractors to immediately provide advance payment for practices struggling to meet the 5010 mandate, permit covered entities to submit and accept version 4010 claims until at least June 30, 2012, and to delay enforcement of 5010 until at least that date.

Many MGMA members have not been paid by Medicare and TRICARE since as far back as November 2011, the association contends. Further, Medicare contractors often say the problem lies with a practice’s claims clearinghouse, while the clearinghouses say the problem lies with Medicare.

“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,” according to the letter. “As the transition to Version 5010 is a mandatory step toward ICD-10 implementation, this raises even more concerns, understanding the magnitude of ICD-10 is exponentially greater than Version 5010.”

Problems practices are experiencing include:

* Practice management or billing systems show no problems during testing but claims are rejected once the production phase starts,

* Secondary payers are not ready,

* Pay-to-address data fields are being stripped from the claim and other address issues have emerged,

* Crosswalk national provider identifier numbers are not being recognized,

* Medicare contractors are losing claims,

* Older submitted validation information is not being transferred,

* Claims are being denied for not having a description in the claim although CMS did not send a notice of correction until Jan. 27,

* Sporadic payment of re-submitted claims are occurring with no explanation for rejections,

* Call hold times of one to two hours are being experienced when contacting Medicare contractors, and

* Unsuccessful claims processing, with no rejection reason cited is occurring, despite using a submitter that was approved by CMS.

The letter to Sebelius is available here.

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