CMS Delays 5010 Enforcement to June 30

The Centers for Medicare and Medicaid Services has extended the non-enforcement period for the HIPAA 5010 transaction sets another 90 days through June 30, 2012.


The Centers for Medicare and Medicaid Services has extended the non-enforcement period for the HIPAA 5010 transaction sets another 90 days through June 30, 2012.

CMS last November announced an enforcement delay through March for the transactions, which had a compliance deadline of Jan. 1, 2012. CMS now says stakeholders continue to make progress, but still have a ways to go. Medicare Fee-For-Service, for instance, has a 70 percent compliance rate for Part A claims and more than 90 percent for Part B.

The Medical Group Management Association is pleased with the CMS decision. The organization on March 15, before CMS announced the extension, had sent a letter to Acting Administrator Marilyn Tavenner recommending an additional 90-day non-enforcement period.

MGMA in the letter also recommended that CMS “strongly encourage” insurers and clearinghouses to provide appropriate and timely feedback to submitters of Version 4010 or non-compliant Version 5010 claims that identify content errors, and continue to monitor industry adoption of 5010 and modify the discretionary enforcement timeframe if necessary.

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