5010 Logjam Means No Pay for Physicians

Joe Cantlupe, for HealthLeaders Media , February 9, 2012

"It's clear that problems will not be resolved overnight," Carmel said this week.

Many physicians report not having been paid by Medicare or TRICARE since November 2011, as a result of the Version 5010 issues, according to the letter sent by MGMA President and CEO Susan Turney, MD, MS, FACP, FACMPE, to Sebelius.

As for CMS, it has little to say publicly on the issue. "HHS has a correspondence response process and CMS will be contributing to development of HHS's response," says Joe Kuchler, a spokesman for CMS, referring to a letter from MGMA. "In the meantime, MGMA's letter is considered open correspondence and we can't comment on specific issues."

While practices have contacted their MACs to receive clarification on the reason for rejected claims, they are provided with little to no information beyond a vague explanation that problems must "lie with your clearinghouse," according to Turney's letter.

Oddly enough, some practices are taking drastic action to try to circumvent the cash flow problems with electronic records. They are reverting to paper claims, Tennant says. "If they have to drop back to paper, we don't recommend it, but if that's the only way to get paid, they may have to take that step," he says. Eventually, however, paperwork may eventually lead to a further backlog of claims, and potential delays in payment.

Tennant says MGMA is recommending that physicians take their cases, if necessary, directly to CMS. "The more complaints CMS hears, the more chance they will take action," he says.

Joe Cantlupe is a senior editor with HealthLeaders Media Online.
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2 comments on "5010 Logjam Means No Pay for Physicians"

hjp (2/10/2012 at 8:07 PM)
It appears the Obama administration is trying to force Physicians to abandon their Private Practices and become hospital employees. Restricting cash flow also deprives Physicians the ability to properly focus their attention and can create the potential for mistakes that open the practice to the risk of a malpractice lawsuit.

taylors (2/9/2012 at 7:07 PM)
This is a situation that was predicted, however we have not run into this problem but only with one MentalHealth carrier so far. Medicare payments have been paid just fine either under old 4010 or the new 5010, with no problems so far. Our plan is to submit both versions of claims so as to avoid massive denials should there be technical problems suddenly. I cannot help but wonder if the Providers billing software is to blame, however that should have become evident in the testing stage. We'd be more than happy to try to assist those Physicians who are in this predicament.




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