• Issues with practice management and/or billing systems. The systems allegedly showed no problems during the testing phase with the practice's Medicare Administrative Contractor, but claims are now being rejected.
• Issues with secondary payors.
• Claims rejections due to various address issues (e.g., pay-to address is not the same as the billing address, no P.O. box address, etc.).
• "Lost" claims with MACs.
• Old submitter validation information not being transferred.
MGMA consequently wrote that HHS needed to take eight action steps, including:
• Instruct MACs to provide immediate advance payments for physician practices that are struggling to meet the Version 5010 mandate.
• Extend the enforcement delay from March 31, 2012, to at least June 30, 2012.
• Allow all covered entities to submit and accept Version 4010 claims until at least June 30, 2012.
• Permit clearinghouses and health insurers to accept and adjudicate Version 5010 claims that do not have all of the required data.