A significant number of medical group practices as well as several state Medicaid programs are not ready for the federally mandated conversion to the ASC X12 Version 5010 electronic transaction standards, according to the Medical Group Management Association-American College of Medical Practice Executives. The group is calling on the CMS to push back the looming Jan. 1 compliance deadline on the upgrade by at least six months.
Implementing the more-robust 5010 standards (versus the Version 4010 standards now in use) are seen as a precursor to updating the International Classification of Diseases 10th Revision family of diagnostic and procedural codes, as is slated for October 2013.
"We are very concerned that at least seven state Medicaid plans, including California, have announced that they will be unable to meet the mandated Jan. 1 deadline," said Dr. Susan Turney, MGMA-ACMPE president and CEO, in a news release. "With the large number of practices reporting that they will revert back to paper claims, we are concerned about the potential delay in adjudicating the large volume of paper claims. Further, the serious challenges in meeting the Version 5010 mandate and the need for a comprehensive contingency plan from HHS call into question the ability of the industry to transition to ICD-10 by the Oct. 13, 2013, compliance deadline."
The MGMA-ACMPE survey results mirror the findings of a report released last week by KLAS Enterprises about a lack of 5010 preparedness among office-based medical practices. Most, according to the report, are relying on their claims clearinghouses or their practice management systems software vendors to pull them through.
According to the MGMA-ACMPE's survey, only 32% of respondents said their management systems had been upgraded to 5010 standards and that internal testing was complete. About one in four reported that their software had not been upgraded or that testing remains unscheduled. Meanwhile, 79% of respondents said that testing with all major commercial health plans was incomplete, and 24% indicated that testing is not scheduled with any major commercial health plan.
"Our main concern is that the failure to implement Version 5010 by the compliance date will impact payment to practices for the services they provide," Turney said.
In mid-November, the CMS backed off a bit, announcing that, while it would keep the Jan. 1 compliance deadline in place for 5010, it would delay enforcement until March 31, 2012.
But that's not enough, according to the MGMA-ACMPE. The group, in the release, called for the CMS to "immediately issue an expanded contingency plan" and permit health plans to continue accepting Version 4010 transactions and adjudicate those claims submitted in Version 5010 but lacking all the required data.
"This contingency plan should last for a minimum of six months," according to the group.