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5010 Logjam Means No Pay for Physicians

Joe Cantlupe, for HealthLeaders Media, February 9, 2012

Problems have been reported with both Medicare administrative contracts and commercial plans.  Some physicians have resorted to taking out lines of credit simply to meet payroll and other expenses. No one seems to be able to pinpoint specific reasons for the cash flow problems.

American Medical Association President Peter W. Carmel tells HealthLeaders Media that over the five weeks since the 5010 standard was implemented, physicians have been "experiencing very alarming problems that have resulted in significant interruptions in claims processing and cash flow."  As a result, more postponements should be made for any enforcement deadline of the HIPAA Version 5010, he says.

Recently, CMS's Office of E-Health Standards and Services (OESS) announced a 90-day period of "enforcement discretion" for compliance with the new 5010 HIPAA transaction standards. CMS extended the 5010 compliance deadline to March 2012 to allow more physician practices the opportunity to implement the new billing-coding standard without incurring penalties.

When asked about the payment issues and the CMS 5010 enforcement deadline, Carmel says: "The AMA fully expects that another extension to the 5010 enforcement deadline will be needed to resolve the emerging issues. We are reviewing timeline recommendations for an extension, but it is clear that no enforcement action should be taken until the vast majority of physicians are being paid in a timely manner under the 5010 standard."

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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.