I love it when I'm held to the highest, most stringent standard possible, but everybody else can do whatever, whenever, why-ever. And nothing happens to them. There are no consequences for the rest of the world for a big general f*** up, but for the doctors, NOOOOOOOOOOO. Hellfire and brimstone will come your way, doc! Make sure the HIPAA 5010 data box doesn't include a PO BOX in your address or you won't get paid. I'm not making this up. (see letter below from MGMA to Kathleen Sebelius regarding the 5010 f*** up).
Department of Health and Human Services
Room 445-G, Hubert H. Humphrey Building
200 Independence Avenue, S.W.
Washington, DC 20201
Dear Secretary Sebelius:
The Medical Group Management Association (MGMA) requests that you take immediate
action to address the payment disruption issues that have occurred as a result of the federally
mandated transition to HIPAA Version 5010 electronic transactions on Jan. 1. Medical
practices throughout the nation are experiencing significant challenges implementing these
new transactions, a situation that has led to considerable cash flow problems for physicians
and their practices. Problems are being reported with both Medicare Administrative
Contractors (MACs) and commercial plans.
Should the government not take the necessary steps, many practices face significantly
delayed revenue, operational difficulties, a reduced ability to treat patients, staff layoffs, or
even the prospect of closing their practice. As the transition to Version 5010 is a mandatory
step toward ICD-10 implementation, this raises even more concerns, understanding the
magnitude of ICD-10 is exponentially greater than Version 5010.
MGMA-ACMPE is the premier association for professional administrators and leaders of
medical group practices. Since 1926, the Association has delivered networking, professional
education and resources, political advocacy and certification for medical practice
professionals. The Association represents 22,500 members who lead 13,200 organizations
nationwide in which some 280,000 physicians provide more than 40 percent of the healthcare
services delivered in the United States.
Version 5010 Issues and Concerns
Physician practices have reported numerous problems across various areas of the United
States stemming from the transition to Version 5010. The most frequently reported problems
have involved:
Issues with practice management and/or billing systems that showed no problems
during the testing phase with their MAC, but once the practice moved into production
phase, found their claims being rejected
Issues with secondary payers
Rejections due to various address issues (pay-to address being stripped/lost from
claims; pay to address can no longer be the same as billing address; no PO Box
address)
Crosswalk NPI numbers not being recognize
Apart from the atrocious grammar and numerous typos, my spirit is simpatico to this letter and I agree the whole thing needs serious pushing back.
My business insurance policy wanted to have some outsourced guy come to the office to photograph the contents, and probably make sure I'm not some fraudulent business. Ok, fine. But this individual failed to show up at the appointed hour, and when called to check on why HE no-showed, some vague ministrations about a long day and so forth were made. We called again and left a message, nobody to actually speak to. This was 2 weeks ago. Today I get a letter from the insurance company that since I "refused" the mandatory inspection my policy would be cancelled. Holy hell!
My agent was sweating bullets and I let him have it. He will have to actually work for a living and attempt to correct this huge mistake. If this is how they do business, the policy will be cancelled. There is competition, still, God bless 'em.
I think there are so many things that have gone awry in the insurance industry that it's beyond repair. The norm is fraud. Therefore, they're on high alert and double check every tiny detail, even my tiny little office in a medical building.
Who knows where this poor outsourced shmo is. He probably quit and there's nobody else who will do this grunt work for minimum wage. Whatever.
