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5010 Deadline Extended, But Threat Remains, Says AMA

Greg Freeman for HealthLeaders Media, February 6, 2012

CMS' Office of E-Health Standards and Services (OESS) has announced a 90-day period of "enforcement discretion" for compliance with the new 5010 HIPAA transaction standards, but leading professional organizations say that is not enough.

Expressing serious concerns about the ability of physician practices and payers to make the conversion to the 5010 electronic transaction standards and ICD-10 (a new code set for medical diagnoses) in time, both MGMA and the AMA are calling for change. The two agencies say that the government needs to form a comprehensive contingency plan permitting health plans to adjudicate claims that may not have all the required data content, or the government needs to call an outright halt to the transition.

CMS has extended the 5010 compliance deadline to March 31, 2012. OESS announced that it is delaying compliance enforcement in order to allow more physician practices the opportunity to implement the new billing coding standard without incurring penalties. The 90-day delay did not affect the implementation date for the coding systems, which took effect 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," OESS said. "It was found that many covered entities are still awaiting software updates and were unable to meet the short deadline."

While enforcement action will not be taken through March, OESS will continue to accept complaints associated with compliance with Version 5010, National Council for Prescription Drug Programs (NCPDP) D.0, and NCPDP 3.0 transaction standards 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.

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