CMS Extends Enforcement Discretion for 5010 Transaction through June 30, 2012

The Centers for Medicare & Medicaid Services’ Office of E-Health Standards and Services (OESS) has announced that it will not initiate enforcement action for an additional three (3) months, through June 30, 2012, against any covered entity that is required to comply with the updated transactions standards adopted under HIPAA: ASC X12 Version 5010 and NCPDP Versions D.0 and 3.0.

According to a CMS press release, although health plans, clearinghouses, providers and software vendors have been making steady progress on being 5010 compliant, “there are still a number of outstanding issues and challenges impeding full implementation.” Therefore, OESS believes that these remaining issues warrant an extension of enforcement discretion to ensure that all entities can complete the transition. OESS expects that transition statistics will reach 98 percent industry wide by the end of the new enforcement discretion period. OESS also announced that it is stepping up its existing outreach to include more technical assistance for covered entities.

The Medicare Administrative Contractors (MAC) are supposed to continue to work closely with clearinghouses, billing vendors or health care providers requiring assistance in submitting and receiving Version 5010 compliant transactions. In addition, the Medicaid program staff at CMS has been directed to continue to work with individual States regarding their program readiness.

ADVOCATE will continue to provide updates as they become available

Best regards,
Kirk Reinitz, CPA
President & CEO