HIPAA 5010 Enforcement Delayed Until June 30

 On Thursday, March 15th, the government announced that it would delay enforcement of HIPAA 5010 transactions until June 30, 2012. This is the second three-month delay on enforcement made by the Centers for Medicare and Medicaid Services (CMS) Office of E-Health Standards and Services (OESS).

OESS stated that: “Health plans, clearinghouses, providers, and software vendors have been making steady progress.” According to OESS:

  • The Medicare Fee-for-Service (FFS) program is 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 show progress as well and some have already made the full transition to Version 5010

However, there are still a number of outstanding issues and challenges that are affecting full implementation. It is these issues that warrant a delay in enforcement. OESS believes that the transition statistics will reach 98 percent industry wide by the end of June. OESS urges those covered by the rule to work more closely on appropriate strategies to resolve remaining problems. To help, OESS is stepping up its outreach to include more technical assistance. OESS is also partnering with several industry groups as well as Medicare FFS and Medicaid to expand technical assistance and eliminate remaining barriers.

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