Eli's Hospice Insider

Published on Tue Jan 17, 2012 PDF

Deadline will depend on your testing status.

Then: In November, the Centers for Medicare & Medicaid Services announced a 90-day "discretionary enforcement period" ending March 31 for 5010 use. As long as providers showed they were making a good faith effort to become compliant with the new HIPAA standards, CMS wouldn't penalize them for not using the 5010, the agency said.

Now: CMS is whistling a different tune in its latest 5010 deadline announcement. For Part B and durable medical equipment claims, "In December 2011, submitters/receivers that have tested and been approved for 5010/D.0 will be notified that they have 30 days to cutover to the 5010/D.0 versions," CMS says in a Dec. 14 e-mail to providers. Part A will start the same deadline a month later, CMS explains.

Why: The CMS Office of E-Health Standards and Services (OESS), which is responsible for HIPAA code set compliance, instituted the delay in the first place because "testing between some covered entities and their trading partners has not yet reached a threshold whereby a majority of covered entities would be able to be in compliance," CMS explains in its original delay statement. "The number of submitters, the volume of transactions, and other testing data used as indicators of the industry's readiness to comply with the new standards have been low across some industry sectors. OESS has also received reports that many covered entities are still awaiting software upgrades."

Even if you're a provider that hasn't tested yet and is getting a break on the 5010 deadline until March, you should still work to get into compliance as soon as possible, suggests Matthew Hawkins, CEO of software vendor Vitera Healthcare Solutions in Tampa, Fla. Taking the time now to upgrade to a 5010-compliant system reduces risk associated with scheduling system upgrades and provides time to certify that systems work appropriately, Hawkins says in a release. "It also puts responsibility on payors to facilitate the 5010 compliant transactions," he adds.