MGMA Calls for New Contingency Plan for HIPAA 5010 Transaction Standards

The Department of Health and Human Services should “immediately” issue an expanded contingency plan on the transition to the new Health Insurance Portability and Accountability Act (HIPAA) Version 5010 electronic transaction standards, since many practices and state Medicaid agencies are not ready for the transition, the Medical Group Management Association (MGMA) recommended Dec. 19.

According to the latest research from MGMA, many state Medicaid plans are unable to accept Version 5010 claims and “a significant number of practices” have not yet completed the software upgrades and health plan testing needed for the transition.

The new contingency measures should permit health plans to continue accepting HIPAA Version 4010 transactions and resolve Version 5010 claims that lack all the required data. Additionally, this contingency plan should last for a minimum of six months, MGMA said.

Currently, the compliance date for implementation of these standards is Jan. 1, 2012.

“We have been tracking the Version 5010 coordination between physician practices and their key trading partners throughout 2011 and it is clear that a significant number of these stakeholders are not ready to meet the January 1 compliance date,” Susan Turney, president and chief executive officer of MGMA, said in a statement. “Our main concern is that the failure to implement Version 5010 by the compliance date will impact payment to practices for the services they provide.”

“We oppose requiring the submission of a transition plan and timeline as a needless bureaucratic exercise that adds to the workload of the providers who have to produce them and the government employees who have to review them,” she said.

Implementation of Version 5010 is a prerequisite for using the updated International Classification of Diseases, 10th Revision (ICD-10) Clinical Modification diagnosis and ICD-10-PCS inpatient procedure code set in electronic health care transactions effective Oct. 1, 2013.

On Nov. 14, the Centers for Medicare & Medicaid Services announced that it would not initiate enforcement of the new HIPAA transaction standards until March 31, 2012 (see previous article).

Additional MGMA Findings

According to findings from a survey conducted by MGMA and the American College of Medical Practice Executives (ACMPE), 32 percent of study respondents reported that their organizations' practice management system software has been upgraded to the HIPAA Version 5010 standards and that internal testing was complete.

Nearly 25 percent of those respondents indicated that either their software has not yet been upgraded or that testing is not even scheduled, the release said.

Additionally, less than 18 percent of respondents to the survey said they have completed testing with their Medicaid plans, and 79 percent of study respondents indicated that testing with all major commercial health plans remains incomplete.

Overall, the study found that less than 14 percent of respondents rate their 5010 implementation status as fully complete.