Contingency Plan Needed for HIPAA 5010 Compliance, Florida Health Experts and Others Say
Who's ready for the January 1 HIPAA 5010
compliance deadline? Not many, according to results of a new study by the Medical Group Management Association (MGMA). Those results have prompted industry officials to ask the Department of Health and Human Services (HHS) to immediately issue a comprehensive contingency plan.
The MGMA wants the HHS to develop a plan that will allow health insurance plans to adjudicate claims even if they lack a portion of the required data content. This will allow practices that are unable to fully meet the New Year's Day deadline to continue practicing without a cash flow disruption. According to the MGMA's study:
- Nearly a fourth of study respondents say they have yet to even hear from their practice management system software vendors regarding the HIPAA 5010 transition;
- Only 35 percent say they've begun internal testing of their new systems;
- Almost a quarter of respondents (21.7percent) have yet to schedule internal testing;
- Just 5.7 percent say they've been contacted by all of their major health plans'
- 35 percent report that a few of their major health plans have contacted them;
- Only 15 percent have begun external testing with all of their major health plans;
- A full 27 percent say external testing has not yet been scheduled;
- Just 4.5 percent say their 5010 implementation is complete;
- 40 percent say their implementation is less than one quarter complete.
"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 January 1 deadline," said Susan Turney, MD, MS, FACP, FACMPE, MGMA president and CEO.
Turney noted study results that show physician practices are developing contingency plans of their own to help dodge financial hardship caused by the expected interruption in cash flow. More than a third (33.3 percent) plan to establish a line of credit at a local financial institution; 35.6 percent will set aside cash reserves to help sustain operations; and more than half (50.6 percent) say they'll go back to paper claims.
"It is unacceptable to expect physician practices to take such drastic action, such as reverting to paper claims, to avoid serious cash flow issues resulting from this mandate," Turney said. "The shift in the industry to electronic transactions in recent years could amplify the problem. Many health plans have transitioned staff away from handling paper claims, and we are concerned that a sudden, large increase in volume could also result in delayed payments."
Are you ready for the Jan. 1 HIPAA 5010 deadline? If you're still having issues,
contact iATROS Healthcare Solutions at 877-900-6763. Our expert EMR and healthcare compliance consultants can help walk you through all portions of your transition to make sure you're up and running with little or no disruption in your cash flow or business operations.