Skip to main content

Last week it was announced that CMS, the governing body for the new HIPAA version 5010 transaction standards, has extended the compliance deadline to March 31, 2012. The Centers for Medicare & Medicaid Services’ Office of E-Health Standards and Services (OESS) is delaying enforcing compliance in order to allow more offices the opportunity to implement this new billing coding standard, without incurring penalties. The 90-day delay does not affect the implementation date for the coding systems, which remains January 1, 2012 (January 1, 2013 for small health plans). Industry feedback played a major role in the decision to push back the compliance date. It was found that many covered entities are still awaiting software updates and were unable to meet the short deadline.

It should be noted that while the penalty date has been extended, OESS will continue to accept complaints associated with compliance during the 90-day period beginning January 1, 2012. If requested by OESS, covered entities that are the subject of complaints (known as “filed-against entities”) must produce evidence of either compliance or a good faith effort to become compliant with the new HIPAA standards during the 90-day period. Failure to comply with the HIPAA 5010 requirement means covered entities might not be paid for their services, as noted in their recent Press Release.

HIPAA version 5010 are the new sets of standards that regulate the electronic transmission of specific healthcare transactions, including eligibility, claim status, referrals, claims, and remittances. Covered entities, such as health plans, healthcare clearinghouses, and healthcare providers, are required to conform to HIPAA 5010 standards.

Many offices are relying on their billing partners to ensure that they remain compliant; however there are some actions that you can take to ensure that your practice is not at risk.

Here are some tips to ensure your software vendors are ready to support the new HIPAA 5010 transaction standards:

  • Confirm with your billing office to ensure they are prepared for the new regulation standards. Be sure to confirm their implementation plan as well as an official roll out date.
  • Consult with your front office staff and make sure they are up to date on how these changes affect their daily activities.
  • Perform an audit of your updated system once it is installed and confirm the new changes are taking effect.

Is your practice ready for these changes? Share with us how your office is prepping for the upcoming HIPAA 5010 changes in the comment section below.

*Quoted reference: CMS Press Release