HIPAA 5010 Enforcement Target Date Moved to End of June

By Bernie Monegain for PhysBizTech.com

The Centers for Medicare & Medicaid Services’ Office of E-Health Standards and Services (OESS) announced on March 15 that it would delay enforcement of HIPAA 5010 transactions to June 30, 2012. It’s the second three-month delay on enforcement made by OESS.

While the rule calls for compliance by Jan. 1, 2012, on Nov. 17, 2011, OESS announced it would not enforce the rule for another three months, referring to the move as “enforcement discretion.”

The OESS statement reads: “Health plans, clearinghouses, providers and software vendors have been making steady progress.”

According to OESS:

  • The Medicare Fee-for-Service (FFS) program is currently reporting successful receipt and processing of over 70 percent of all Part A claims and over 90 percent of all Part B claims in the Version 5010 format.
  • Commercial plans are reporting similar numbers.
  • State Medicaid agencies are showing progress as well, and some have made a full transition to Version 5010.

“At the same time, OESS is aware that there are still a number of outstanding issues and challenges impeding full implementation,” the OESS statement continued. “OESS believes that these remaining issues warrant an extension of enforcement discretion to ensure that all entities can complete the transition. OESS expects that transition statistics will reach 98 percent industry-wide by the end of the enforcement discretion period.”

OESS urged those covered by the rule to collaborate more closely on appropriate strategies to resolve remaining problems. The statement said the agency would step up its existing outreach to include more technical assistance for covered entities. OESS is also partnering with several industry groups as well as Medicare FFS and Medicaid to expand technical assistance opportunities and eliminate remaining barriers.

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