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HIPAA 5010 Enforcement Extension Expires in Four Weeks

A significant number of physician practices may already or could soon face serious cash-flow issues, due to non-compliance with new HIPAA 5010 data standards that went into effect Jan. 1. CMS has delayed enforcement to March 31 from Jan. 1, but only a few weeks remain in the enforcement extension. Although it appears that CMS will delay implementation of ICD-10, there is no indication that the HIPAA 5010 deadlines will change. Assume that enforcement will begin April 1.

What you need to know

  • All systems must be compliant with HIPAA 5010 standards by April 1. If they are not, all claims—including Workers Compensation in many states—may be rejected. Depending on your payers' contingency plans, your practice may not get paid beginning April 1. Again: All transactions in the previous 4010 format may be rejected.
  • Keep testing. Wherever you are in the process, keep testing often and work to correct errors. Don't just rely on your vendors. For the latest information on key errors to look for or codes to test, visit the CMS website.
  • Report problems. According to some reports, at least 25 percent of practices cannot successfully process Medicare Part B submissions. The AMA is coordinating an effort to determine the scope and source(s) of problems reporting. If your practice has experienced issues with vendors or your Medicare vendors, report these problems to the AMA.

If your practice will miss the deadline

  • Start contacting your payers to see what options or back-up plan they may have in place. Begin with your top 10 payers. It is possible that some clearinghouses/vendors will have a system in place to convert non-compliant claims, but you should find out what your payers' plans are.
  • Keep testing often and work to correct errors. Don't just rely on your vendors.
  • Report any issues with vendor readiness to your carrier. Report any other issues to the AMA.
  • More information, plus implementation guidelines: www.aao.org/hipaa5010.

If you are a small practice

  • If you already know your practice will not be ready by April 1, start contacting your payers to see what options or back-up plan they may have in place. Begin with your top 10 payers. It is possible that some clearinghouses/vendors will have a system in place to convert non-compliant claims, but you should find out what your payers

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