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5010 Logjam Means No Pay for Physicians

Joe Cantlupe, for HealthLeaders Media, February 9, 2012

"These problems are particularly troubling since cash-strapped physicians are burdened with meeting several other government requirements, including quality reporting, e-prescribing, meaningful use, and of course, ICD-10," Carmel adds.

Specifically, MGMA has called for an extension of the enforcement delay from March 1, 2012 to June 1, 2012.  In a letter to HHS Secretary Kathleen Sebelius, MGMA has recommended to instruct MACs (Medicare Administrative Contractors) to "immediately" provide advance payments for physician practices that are struggling to meet the Version 5010.

Moreover, HHS was asked to permit clearinghouses and health plans to accept and adjudicate Version 5010 claims that do not have all the required data content, and instruct the MACs to expeditiously adjudicate all outstanding claims.

Physician groups say that the government needs to take prompt action because physician practices may eventually face delayed revenue and operational difficulties, reduced ability to treat patients, or even the prospect of closing practices. MGMA officials have not specified any specific impacts from the situation.

The situation highlights the delicate balance of uncertainties between government mandates and private physician groups.  It spotlights the issue of the fragile, and possibly tentative steps needed to enforce new deadlines. Physician groups also raise concerns about the moves toward ICD-10, considering that the magnitude of that mandate is even greater than Version 5010's reach.

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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.