CMS Delays Enforcement of HIPAA 5010-Compliance Date Remains

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Gavin Walker
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CMS Delays Enforcement of HIPAA 5010-Compliance Date Remains

Post by Gavin Walker » Fri Nov 18, 2011 5:45 pm

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 ANSI 5010 compliance date remains January 1, 2012. 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, 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.
    • If you have plans to upgrade your practice management system to a 5010-compliant version, please continue with the upgrades as planned.
    • Test that your system is 5010-compliant as soon as possible to ensure that you are ready to submit 5010-compliant claims when your payers are ready to accept them.
    • You are responsible for making updates to your current production environment to ensure the smooth transition to 5010 production standards. RelayHealth 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.
o Common 5010 Institutional Rejections and Requirements
o Common 5010 Professional Rejections and Requirements
Gavin Walker
Walker Tek Solutions, LLC
417-890-6777 x0
fax: 417-763-6386


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