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5010 Logjam Means No Pay for Physicians

Joe Cantlupe, for HealthLeaders Media, February 9, 2012

A strange thing is happening as physician practices transition toward HIPAA version 5010 electronic transactions.

Docs aren't getting paid.

Physicians are flooding their advocacy groups with complaints and questions about "cash flow problems." One physician broke down in tears about his inability to pay his staff.

"We haven't seen anything like this before," said Robert Tennant, MA, senior policy advisory at MGMA, referring to the emails from distraught doctors.

The problems have intensified over the past month. Since the mandated transition to HIPAA Version 5010 began Jan. 1, data disruptions, unforeseen rejections of claims, and improper mailings because of address issues have stopped docs from getting paid.  

Beyond that, communication snafus with clearinghouses and secondary payers have been a problem. The bottom line: These issues and more are resulting in payments not making it to physician offices, according to MGMA.

While the number of physicians impacted, has not been specified, it is likely in the thousands. A flurry of meetings and emails between the Centers for Medicare & Medicaid Services and physician groups is underway, but authorities don't expect any resolution to the issues for weeks.

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2 comments on "5010 Logjam Means No Pay for Physicians"


hjp (2/10/2012 at 8:07 PM)
It appears the Obama administration is trying to force Physicians to abandon their Private Practices and become hospital employees. Restricting cash flow also deprives Physicians the ability to properly focus their attention and can create the potential for mistakes that open the practice to the risk of a malpractice lawsuit.

taylors (2/9/2012 at 7:07 PM)
This is a situation that was predicted, however we have not run into this problem but only with one MentalHealth carrier so far. Medicare payments have been paid just fine either under old 4010 or the new 5010, with no problems so far. Our plan is to submit both versions of claims so as to avoid massive denials should there be technical problems suddenly. I cannot help but wonder if the Providers billing software is to blame, however that should have become evident in the testing stage. We'd be more than happy to try to assist those Physicians who are in this predicament.