Revenue Cycle Management Blog | GroupOne Health Source

HIPAA 5010 Enforcement Delay Pitfalls

Written by Kaitlyn Houseman | December 2, 2011

"It's not a good idea to get too comfortable with the extension," according to industry experts.

Even with the Centers for Medicare & Medicaid Services' (CMS) recently announced 90-day discretionary enforcement period (March 21 versus Jan. 1) for physicians to transition to HIPAA Version 5010 for claims transmission, physician practices must stay on task, making a "good faith effort" toward on-time compliance.

Remember, CMS has not granted a true extension, but merely a grace period, as AHIMA-certified coding trainer Pati Hildebrand recently told Physicians Practice.

AMA President Peter Carmel agrees.  The AMA "highly recommends" physicians continue their efforts to continue the transition to 5010 as if this extension had not occurred.

"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," she said. "Any claims or bills they submit after Jan 1, 2012, that are not in HIPAA 5010 will still get rejected, but this delay in enforcement will also allow them to resubmit in the appropriate HIPAA 5010 format without penalty."


Nonetheless, the wiggle room will provide many physicians some much-needed relief in managing the transition, as not only are most physician practices woefully behind schedule, but so are some payers in getting ready to accept the new claims format.

Particularly with regard to small payers and some small Medicaid carriers, this means that physician groups and hospitals might have to continue to file some claims in the 5010 format and some in the current 4010 format, unless clearinghouses can translate the claims back to 4010, reports InformationWeek.

For most practices, even with the new deadline, there is much work to be done with vendors in terms of planning and testing. And as the switch draws closer, practices must communicate with their vendors to determine when exactly technology upgrades will take place and how much each service will cost, notes a recent post from the Medical Group Management Association blog.

Citations from Marisa Torrieri and Physicians Practice.