WebNews 5010 Enforcement Delayed Again

CMS Announces Extension of Enforcement Discretion Period for Updated HIPAA Transaction Standards (5010)

The Centers for Medicare and Medicaid (CMS) issued an announcement on March 15, 2012 which extends the Enforcement Discretion Period for 5010 Transaction data sets. CMS noted it will not initiate enforcement action for an additional three (3) months, through June 30, 2012, against any covered entity that is required to comply with the updated transactions standards adopted under the Health Insurance Portability and Accountability Act of 1996 (HIPAA): ASC X12 Version 5010 and NCPDP Versions D.0 and 3.0.

The original 90-day discretionary period was to end April 1, 2012. The notice stated that currently 70% of Part A and 90 % of Part B claims are 5010-compliant, and CMS expects this number to rise to 98% by the new date. Under the previous guidelines, covered entities were encouraged to complete outstanding implementation activities including software installation. That has not changed.

The important points of the new date are:

  1. MACs will accept either 4010 or 5010 claims through the new June 30, 2012 date.
  2. After this, claims must be submitted via 5010 format.
  3. The latest announcement can be downloaded at this link: http://www.cms.gov/ICD10/.

We believe that you should have a Transition Compliance plan for 5010 in place, and should be speaking with vendors and clearinghouses to resolve any outstanding 5010 issues.

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