CMS grants HIPAA 5010 stragglers more time

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time struggle - 456.44 Kb

As the Jan. 1, 2012 deadline to transition to HIPAA 5010 encroaches, those who are ill prepared for the change can breathe a sigh of relief—at least for two more months. On Nov. 17, the Centers for Medicare & Medicaid Services’ (CMS) Office of E-Health Standards and Services (OESS) said it will not enforce action until March 31, 2012, which is good news for unprepared practices as not meeting this deadline could disrupt cash flow.

While the CMS said it will prolong enforcement of the rule that requires practices to adopt the robust claims standards, the Jan. 1, 2012, compliance date for the use of these standards still stands, according to a release by CMS.

In an Oct. 26 statement released by the Medical Group Management Association (MGMA), only 4.5 percent of study respondents rated their 5010 implementation status as complete while 40 percent said that their implementation status is less than one-quarter complete.

The CMS urged all practices to continue working with vendors and partners to become compliant with the new HIPAA standards and to run tests that will determine their readiness to accept the new standards beginning Jan. 1, 2012.

OESS made the decision to push back the enforcement period after industry feedback revealed that with only about 45 days remaining before the Jan. 1, 2012, deadline hits, many practices have not reached and would not reach compliance.

Version 5010 will provide a greater functionality to healthcare claims and is also a prerequisite to transitioning to the ICD-10 CM and ICD-10-PCS code set, which will become mandatory Oct. 1, 2013. Earlier this week, the American Medical Association (AMA) House of Delegates voted to try and halt ICD-10 code implementation, due to the significant burdens that will be placed on practices. It was estimated that a 10-physician practice could be forced to fork over $285,195 to complete the implementation phase of the ICD-10 code set.

Additionally, respondents in a recent MGMA survey estimated that converting 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, even though 53.4 percent said that they were fully aware of the upcoming mandates.

CMS’ OESS said that it will continue to accept complaints associated with Version 5010 during the 90-day period beginning Jan. 1, 2012. If requested, those subject to complaints must provide “evidence of either compliance or a good faith effort to become compliant with the new HIPAA standards during the 90-day period.”