E-Transaction Standards Deadline Worries Grow - InformationWeek

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10/26/2011
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E-Transaction Standards Deadline Worries Grow

Medical Group Management Association fears that cash flow will stop because many practices aren't ready for new transaction standards.

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The Medical Group Management Association (MGMA) has become the latest organization to ask federal officials to develop a contingency plan so health insurers can legally pay claims that don't follow the ANSI X12 version 5010 standards that become mandatory January 1. Otherwise, physician practices are likely to suffer crippling slowdowns in their cash flow, the organization said.

The Healthcare Information and Management Systems Society (HIMSS) already has recommended that providers create their own contingency plans with payers and other business partners.

In this case, MGMA wants the Centers for Medicare and Medicaid Services (CMS) to give the OK for health plans to accept electronic claims not fully compliant with 5010 as long as the transactions contain enough data to adjudicate claims. "The industry is going to survive if some of the codes are incomplete," MGMA government affairs manager Robert Tennant said Tuesday at the organization's annual conference in Las Vegas.

There is precedent for such a move. In 2002, when the Health Insurance Portability and Accountability Act (HIPAA) transactions standards first took effect with the still-in-use version 4010A1, CMS implemented a contingency plan to keep payments flowing when it became apparent that many providers, payers, practice management software vendors, and transaction clearinghouses were not ready. That leniency lasted for several years.

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Once again, it appears that preparations are lagging. MGMA on Monday released results of a survey indicating that just 4.5% of its member practices had completed their 5010 implementations. A mere 5.7% of members said they had heard from all major health plans that they contract with to test 5010 transaction capability. While that represents progress from a July survey, the majority of practices queried are unlikely to have full compliance by the first of the year.

"It is clear that a significant number of medical groups will not have the ability to transmit claims and other electronic transactions using the Version 5010 format by the Jan. 1 deadline," said new MGMA CEO Dr. Susan Turney, who took over upon Dr. William F. Jessee's retirement this month.

MGMA, which officially merged with its sister organization, the American College of Medical Practice Executives this week and is changing its name in January to MGMA-ACMPE, also joined the growing chorus of those wanting wants CMS to delay until 2014 the second stage of the Meaningful Use incentive program for healthcare providers to adopt electronic health records (EHRs).

MGMA contends that the slow pace of physicians and other eligible providers earning Stage 1 bonus payments this year is evidence that 2013 is too ambitious of a start date for Stage 2, given that CMS won't finalize the rules until the middle of next year. "We can always push them to do more down the road, but they need to get the technology in place to start," Tennant said.

During a Q&A session with MGMA members on Monday, national health IT coordinator Dr. Farzad Mostashari reiterated his previously stated support for pushing Stage 2 back to 2014 for providers that reach Stage 1 this year. "I think he's heard loud and clear that people need more time," according to Tennant.

Additionally, MGMA raised concerns about the CMS e-prescribing incentive program, which will reduce Medicare payments by 1% in 2012 for physicians who did not write at least 10% of their prescriptions electronically in the first half of this year. Physicians have until Nov. 1 to apply for a hardship exemption, but CMS won't inform them if they met the threshold until December. Turney called that schedule "fundamentally flawed."

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