5010 Logjam Means No Pay for Physicians

Joe Cantlupe, 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.

Joe Cantlupe Joe Cantlupe is a senior editor with HealthLeaders Media Online.Twitter


Facebook icon
LinkedIn icon
Twitter icon