HIPAA 5010 Enforcement Delay Good for Practices

November 28, 2011

While CMS is giving practices a little leeway with 5010, it’s not a good idea to get too comfortable with the extension.

The decision made Nov. 17 by the Centers for Medicare and Medicaid Services to delay enforcement of HIPAA 5010 transaction standards - slated to go into effect Jan. 1, 2012 - will definitely help some practices scrambling to get ready. 

But while CMS is giving practices a little leeway with 5010, it’s not a good idea to get too comfortable with the extension, sources told Physicians Practice.

“It’s a big deal for physicians practices because if CMS didn’t back it up there would have been a revenue-cycle train wreck,” said Richard Temple, a healthcare consultant with Beacon Partners, adding that the process of transitioning from Version 4010 to 5010 is much more difficult than many providers and vendors estimated.

Still, American Medical Association president Peter Carmel said in a statement that his organization “highly recommends” physicians continue their efforts to continue the transition to 5010 as they were.

“Complaints can be registered against physicians who have not fully transitioned to the new standard by Jan. 1,” said Carmel. “Physicians facing a complaint will need to provide evidence of compliance, or a good faith effort to become compliant during the 90-day grace period.”

AHIMA-certified coding trainer Pati Hildebrand, executive director of Hildebrand Healthcare Consulting, reiterated that practices must remember CMS did not remove the 5010 compliance requirement.

“I’m betting that some organizations will think this means they don’t have to implement HIPAA 5010 for another 90 days, but that would be wrong,” Hildebrand told Physicians Practice. “Any claims or bills they submit after Jan 1, 2012, that are not in HIPA 5010 will still get rejected, but this delay in enforcement will also allow them to resubmit in the appropriate HIPAA 5010 format without penalty.”

Respondents to a recent survey by the Medical Group Medical Association (MGMA) estimated that upgrading to HIPAA 5010 could set them back $16,575, and 45.2 percent of practices said that they had not yet started the implementation of software upgrades necessary for HIPAA 5010, according to reports.

When news of the CMS 5010 enforcement delay broke last week, MGMA senior policy advisor Robert Tennant said the push back of 5010 will offer some relief to providers, but it may not go far enough.

“This message [Nov. 17] that enforcement would be delayed 90 days was a step in the right direction,” he said. “However, we remain concerned that critical provider trading partners, including practice management system vendors and health plans, will not be ready by the compliance date.”