Physicians Get Grace Period from CMS on HIPAA 5010 Enforcement

November 18, 2011

CMS will look the other way until March 31, 2012, but the Jan. 1, 2012, compliance deadline for providers won’t budge.

The Centers for Medicare and Medicaid Services announced Nov. 17 it will push back plans to enforce use of the HIPAA Version 5010 transaction standard until March 31, 2012.

CMS noted that the compliance deadline Jan. 1, 2012, is still in effect, and that the Office of E-Health Standards and Services, which is in charge of enforcing 5010, will accept complaints associated with compliance with Version 5010 transaction standards during the 90-day period beginning on that date.

According to CMS, OESS made the decision for a discretionary enforcement period based on industry feedback revealing that, with only about 45 days remaining before the January 1, 2012, compliance date, testing between some covered entities, including physicians and insurers, and their trading partners, including vendors, has not yet reached a threshold whereby a majority of covered entities would be able to be in compliance by January 1.

“Feedback indicates that the number of submitters, the volume of transactions, and other testing data used as indicators of the industry’s readiness to comply with the new standards have been low across some industry sectors,” CMS stated. “OESS has also received reports that many covered entities are still awaiting software upgrades.”

CMS also said:“If requested by OESS, covered entities that are the subject of complaints must produce evidence of either compliance or a good faith effort to become compliant with the new HIPAA standards during the 90-day period.” 

A big number of physician practices are included among those who aren’t ready for the shift to 5010.

Robert Tennant, senior policy advisor with the Medical Group Management Association (MGMA) said the news is a great start.

“As you know, MGMA has been calling on CMS to issue a comprehensive contingency plan to avoid a potentially significant cash flow disruption on Jan 1,” Tennant told Physicians Practice via e-mail. “This message [Nov. 17] that enforcement would be delayed 90 days was a step in the right direction. 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.”

MGMA is urging CMS to vigorously monitor each stakeholder group for their readiness to conduct compliant 5010 transactions, said Tennant.

“Should the evidence suggest that one or more stakeholders will not be ready,” he said, “CMS should permit health plans to accept non-compliant transactions to ensure that there is minimal negative impact on providers and the patients they treat.”