Last spring, ClaimCare Medical Billing Company began notifying clients about inherent issues of the HIPAA 5010 mandate. We have continued working to guide clients through the standardized electronic requirements. Recently, many physicians with whom we have spoken have said they are only learning about these 5010 issues from ClaimCare. They are asking “Why isn’t there anything about these 5010 collections problems on the medical association sites?” It is understandable physicians ask this question. We have asked the question for almost a year. This is not an indictment against any state medical association, just an honest question.
The Texas Medical Association came on board February 1 to help distribute concerns, posting an article on its site about HIPAA 5010 potholes: Are Your Claims Being Rejected? Hopefully, other states that have not already done so will follow suit. This past December the Medical Group Management Association (MGMA) had issued a press release titled: Healthcare industry not ready for 5010; MGMA calls for 6-month contingency plan. Now, in a letter sent to U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius, MGMA President/CEO Dr. Susan Turney writes (click here for copy of the full letter):
“New federal standards designed to streamline electronic insurance claims are instead slowing them down, hurting physician cash flow and pushing some practices into financial distress... Many practices face significantly delayed revenue, operational difficulties, a reduced ability to treat patients, staff layoffs, or even the prospect of closing their practice."
Medscape.com posted an article on February 3 about the MGMA letter titled: Physician Groups Say 5010 Standards Hurt Cash Flow. This was preceded by the Physicians Practice “dire situation” article in December to which we referred in an earlier posting: New Year Comes with New Challenges in Healthcare Reimbursement.
As we re-emphasized in our December 19, 2011 update to clients, and then again in January, the 5010 is a format in which all clearinghouses, payers and providers must submit claims. Unfortunately, not all parties have complied in a timely manner. As a result, 5010 has hit some with the fury of a hurricane. Delays in claims acceptance and payments from Medicare and other payers such as BCBS and Cigna are occurring across the nation, and your practice is most likely experiencing decreased collections.
The ClaimCare EDI team continues to work diligently (and literally around the clock) to help resolve these issues and insure that all claims and claim files are received and confirmed at each level of the submission process. This is one of the reasons that our clients are not among the unfortunate groups that have had no Medicare payments since November 2011! Many of the delays, however, are 100% with the payers. These delays will continue until the payers correct the internal system issues that are leading to erroneous claim rejections and general processing delays. This payer-problem is one of the situations we anticipated and to which we referred in the 5010 communications we sent clients in December and January.
We continue to communicate with our clients on “known issues” at payer (CMS, BCBS, etc.) and clearinghouse levels. Most issues are being resolved by the payers and clearinghouses. Many other file transmission issues have been resolved through recent upgrading or patching we have performed for our clients and their practice management systems and/or via a plug-in that is designed to help translate the transmitted data into the corrected formats.
If you are not getting the information you need about the impact that 5010 is having on your practice and would like to learn what ClaimCare Medical Billing Company can do to help you, we invite you to contact us at (877) 440-3044. As far as HIPAA 5010 is concerned, we remain on the forefront of testing and successful transmission and believe for practices that are prepared to take advantage of the opportunity, relief is in sight.
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Copyright 2012 by Carl Mays II, CEO/President of ClaimCare Medical Billing Services, one of the largest medical billing companies located 100% in the United States. In 2012, Money & Business, the online magazine that provides comprehensive coverage of financial matters, named the ClaimCare Medical Billing Company among the top five online medical billing companies.