MGMA Wants 5010 Relief

The Medical Group Management Association (MGMA) urged the U.S. Department of Health & Human Services (HHS) Feb. 1 to alleviate payment disruptions resulting from the recent implementation of the 5010 documentation standard. The group asked for the delay of enforcement penalties, already delayed to March 31, to be extended an additional three months to June 30.

In a letter, Susan Turney, MD, MGMA president and CEO, said delayed revenue will hit practices through operational difficulties, layoffs, and, for some, the prospect of closing practices. A long list of payment difficulties encountered by members includes the following, the letter said:

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  • Claims denied by Medicare administrative contractors (MACs) despite 5010 testing having showed no problems
  • Issues with secondary payers
  • Crosswalk National Provider Identifier (NPI) numbers not being recognized
  • Lost claims with MACs
  • Sporadic payment of re-submitted claims

MGMA says many of its members have suffered long delays of payment from Medicare and TRICARE, with some practices not having been paid since November 2011 because of 5010 issues.

In addition to extending the deadline, MGMA urged HHS to instruct MACs to provide advance payments to practices struggling to meet the 5010 mandate. The group also asked that practices be allowed to follow the 4010 documentation standard until June 30.

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