Mandatory HIPAA 5010 Compliance Now Extended to March 2012

In observance with the healthcare industry feedback, Medicare has delayed enforcement of HIPAA 5010 standards. CMS (The Centers for Medicare and Medicaid Services) issued a statement on Thursday (November 17, 2011), clearly mentioning a 90-day discretionary period for ensuring compliance with updated HIPAA Transaction Standards, i.e. HIPAA 5010.

As a result, last date for establishing HIPAA 500 compliance that was initially scheduled for January 1, 2012 has now been extended to the end of March 2012.

Brief of HIPAA 5010
Please note that HIPAA 5010 doesn’t represent drastic changes in comparison to the earlier HIPAA benchmarks. It is essentially puts forth a more comprehensive way for ensuring data integrity and security during transaction processing. It seeks to neutralize any uncertainties in the healthcare information processing methodologies being used currently. Following HIPAA 5010 Rule is also vital to ensure easy migration towards the ICD-10 Diagnostic Codes that will be launched in 2013.

What this extension means?
1. Physician offices and healthcare facilities now have more time to ensure that they upgrade to the latest benchmarks for electronic transaction processing of insurance claims since HIPAA 5010 specifically covers medical billing & coding data.

2. This extension applies to all healthcare facilities, including hospitals and physician offices, and their business associates that are not in compliance with standards categorized under:

  • ASC X12 Version 5010 (Version 5010)
  • NCPDP Telecom D.0 (NCPDP D.0)
  • NCPDP Medicaid Subrogation 3.0 (NCPDP 3.0)

3. OESS or the Office of eHealth Standards and Services will not be taking any action related to non-compliance with 5010 transaction benchmarks during the extended period. However, OESS will continue to accept complaints for HIPAA 5010 non-compliance.

4. OESS will continue to enjoy the authority of asking covered entities to provide sufficient evidence regarding their efforts for ensuring HIPAA 5010 compliance during the extended period.

What lead to this extension?
Transition towards complete compliance with HIPAA 5010 has seen many trends that have induced this somewhat-expected extension:

  • Adoption of HIPAA 5010 is a bit time-consuming since it does induce some financial stress. Industry feedback indicated that the overall degree of readiness to adopt the HIPAA 5010 standards was lower-than-expected.
  • Decision made by the OESS is essentially a result of industry feedback where many covered entities and their business associates had been unable to achieve a basic degree of observance of HIPAA 5010 standards.
  • OESS was also sensitized to the issue that many covered entities are still awaiting the software upgrades they had put in motion.
  • Hospitals seem to have a greater degree of preparedness when compared to physician groups, i.e. in following HIPAA 500 guidelines. This is due to the fact that there are more vendors offering updated, Hospital Information Systems.
  • Practice Management Systems that are mainly used by physician offices have seen little enthusiasm among the vendors leading to lack of updated software applications.
  • Many of the bigger, reputed vendors are also guilty of not upgrading their software solutions to meet the HIPAA 5010 requirements.
  • Some physician groups haven’t even tested the new 5010 format for submitting their claims, leading to more delays.
  • Many commercial and Medicare carriers are willing to accept claims forwarded in the 5010 format but acceptance of the same has been an issue with some Medicaid programs. This means some physician offices being made to submit claims in the 5010 & 4010 format which is both confusing and time-consuming.
  • Some of the Healthcare Management Systems have the capability of generating claims in both formats but their numbers and usage is rather restricted.
  • OESS wanted to ensure that such issues that could lead to complete denial of claims and unwanted claims re-processing costs were prevented.