CMS Delays Enforcement of HIPAA 5010; Compliance Date Remains January 1, 2012

November 22, 2011

CMS Delays Enforcement of HIPAA 5010; Compliance Date Remains January 1, 2012
On November 17, the Centers for Medicare and Medicaid Services' Office of E-Health Standards and Services (OESS) announced that it will not enforce compliance with the ASC X21 Version 5010 (a.k.a. ANSI 5010) standards until March 31, 2012. However, the January 1, 2012 ANSI 5010 compliance date remains in effect. Essentially the OESS, which enforces compliance with HIPAA transaction and code set standards (i.e., ANSI 5010), is granting a grace period to ensure that the industry has fully tested for 5010 before it takes enforcement action against HIPAA-covered entities that are not compliant. A HIPAA-covered entity is any healthcare provider that conducts certain transactions in electronic format as well as clearinghouses and health plans.
CMS made this decision with 45 days remaining until the January 1, 2012 compliance date because:
  • Testing by the covered entities and their trading partners had not reached a threshold whereby a majority of covered entities would be compliant by January 1, 2012.
  • The number of submitters and volume of transactions and testing data used as indicators of 5010 readiness have been low across some industry sectors.
  • Many covered entities are still completing software upgrades.
What does this mean to you? 
  • To reiterate, the compliance date for 5010 has not changed. Per CMS, payers that are certified on 5010 can enforce and require 5010-formatted claims beginning January 1, 2012.
  • CMS encourages covered entities to continue work to be 5010-compliant by January 1, 2012.
  • McKesson's 5010-compliant practice management products for independent and group practices are Medisoft Version 17, Lytec 2011, Practice Partner 9.5.2 and Horizon Practice Plus 12.5.
  • If your practice has plans to upgrade its McKesson practice management system to a 5010-compliant version, please continue with the upgrade as planned.
  • If you have not purchased or scheduled your upgrade to a 5010-compliant release, please do so as soon as possible to ensure that your practice is ready to submit 5010-compliant claims when your payers are ready to accept them. Contact your McKesson representative or value added reseller to request your upgrade.
What does your practice need to do?
Once you are live on a 5010-compliant practice management system you should work with your clearinghouse and/or payers to test your 5010 transactions. In addition, you are responsible for making updates to your current production environment to ensure your smooth transition to 5010 production standards. The RelayHealth clearinghouse has been actively testing 5010 claim transactions with Medicare, Medicaid, BlueCross BlueShield, and commercial payer lines of business. Through their extensive testing, they have identified that each payer line of business is continuing to reject test claims from providers because they do not meet 5010 Errata requirements. Please review these common rejections and requirements, and update your production environment accordingly:

If you have questions about the steps you need to take to be ready for 5010, please contact your McKesson representative or value added reseller.

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