The compliance deadline for the Version 5010 conversion is Jan. 1, 2012.
Last month at its annual meeting, the Medical Group Management Association asked the CMS to “immediately issue a comprehensive contingency plan,” AKA a Plan B, that would permit health plans to continue to process non-compliant healthcare claims.
The MGMA made the call after a survey of its members indicated that only 35% of responding groups had begun internal testing for 5010 use with better than one in five practices (nearly 22%) had not even scheduled internal testing with the practice management system vendors.
According to several industry timelines, internal testing for 5010 was to have been completed in January and, by this time, covered entities were to be wrapping up external testing of 5010 communications with their trading partners.
Robert Tennant, the MGMA's Washington-based senior policy adviser, said in an e-mail the CMS action was “similar to what we called for” in its October announcement.
Tennant said it was “good they didn't wait” until the end of December to make the announcement, but it still doesn't solve all of the problems dead ahead.
“Obviously, we're pleased they recognized the fact that providers are still challenged to meet this Jan. 1 compliance date,” Tennant said. “We continue to be concerned about the ability of health plans to accept a 5010 claim that might not have all of the content, but enough content to adjudicate a claim.
California, for example, announced a couple of weeks ago that its Medicaid program will not be able to meet the 5010 compliance deadline, Tennant said.
“It's not the only state that won't be ready,” he predicts. “There are number states.”
“The CMS has to look seriously about allowing 4010 claims for a considerable length of time,” Tennant said. “We strongly encourage the government to monitor the industry. If things don't improve, they'll have to look seriously about augmenting this decision they made today.”