Playing Catch-up on 5010


Denise Buenning and Journal writer Chris Dimick discuss the progress of the industry’s conversion to version 5010, how OESS will handle enforcement, and how the upgrade will simplify currently complex transactions.

Covered entities that missed the January 1 deadline to upgrade to the ASC X12 Version 5010 HIPAA transaction standards need to work fast. The Centers for Medicare and Medicaid Services has delayed enforcement until March 31, but it does not anticipate extending it further, says Denise Buenning, director of the administrative simplification group in CMS’s Office of E-Health Standards and Services (OESS).

The HIPAA transaction standards are used in the electronic exchange of administrative and financial information between healthcare providers, clearinghouses, and health plans. CMS first announced the upgrade from version 4010 to version 5010 in January 2009.

OESS decided to delay enforcement in November 2011 after receiving industry feedback that many providers and their trading partners were running late. Though it postponed enforcement, OESS did not change the implementation deadline—and it will track industry complaints against those covered entities that were not compliant as of January 1.

Small providers had the most difficulty getting upgrades implemented and tested to ensure transactions were submitted properly, Buenning says. However, the industry overall has accelerated its efforts in the past months, and OESS expects that the majority of covered entities will have transitioned successfully when enforcement begins March 31.

Federal and State Progress

Medicare’s fee-for-service program encouraged its trading partners to test their 5010 implementations early to avoid a rush. This helped steadily shift the industry toward compliance, Buenning says.

Though several state Medicaid programs were unable to meet the January 1 implementation deadline, CMS has been working closely with Medicaid regulators to ensure nearly all states can accept version 5010 transactions by the enforcement deadline, according to Buenning. As of mid-January, OESS had not received any formal complaints that a covered entity was not using 5010.

“We are always interested in receiving feedback. I don’t want to give folks the impression that we think that everything is blue sky out there, so we certainly do welcome receiving information about any issues or concerns that they are having so that we can help to mitigate that,” Buenning says.

Entities that do not comply could face up to $1.5 million in fines from CMS, according to Buenning. The HITECH Act upped the fine from $25,000 in 2010. However, to date OESS has never progressed to the penalty phase for transaction noncompliance, because, Buenning says, “Our goal is to achieve compliance, and we work very closely with the complainants and the filed-against-entities to make sure that they do work toward compliance.”

For more on the HIPAA transaction standards, look for the cover story in the February print issue, which explores the coming operating rules intended to standardize the industry’s use of the standards.

1 Comment

  1. this is interesting. Do we know how many extensions there will be? What percentage will be compliant by Jan.2013

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