A Second Delay for 5010

The Centers for Medicare and Medicaid Services has again delayed enforcement of the HIPAA 5010 transaction standards, pushing the deadline back three months to June 30, 2012.

This is CMS’s second delay to the original January 1 deadline. The agency announced a three-month enforcement delay in late 2011 after its Office of E-Health Standards and Services (OESS) received feedback indicating a significant portion of the industry was not ready to use the standards. Health plans, clearinghouses, providers, and software vendors use the transaction standards to complete administrative and financial transactions related to healthcare.

The official compliance deadline still stands at January 1, 2012, and OESS has urged entities to continue steady implementation efforts including software installation, testing and training despite the enforcement delay.

“OESS is aware that there are still a number of outstanding issues and challenges impeding full implementation,” read a CMS press release e-mailed to the media today. “OESS believes that these remaining issues warrant an extension of enforcement discretion to ensure that all entities can complete the transition.”

OESS promised to step up existing outreach efforts by offering more technical assistance to HIPAA-covered entities, and said it is partnering with several industry groups to “eliminate remaining barriers” to 5010 implementation.

While acknowledging that a lack of widespread implementation of the standards is to blame for the continuing delays, OESS said the industry is making “steady progress” toward 5010. The Medicare Fee-for-Service program has reported the 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, according to the press release. Commercial plans are reporting similar numbers, and several state Medicaid agencies have made a full transition to 5010.

However, many Medicaid agencies have had difficulty transitioning to 5010, and some providers have reported problems both using 5010 and receiving payment through the updated system.

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