CMS Delays Version 5010 Compliance Enforcement

30 Dec

The Centers for Medicare & Medicaid Services announced last month that it will delay its requirement for the adoption of a more-robust set of claims transmission standards.

Originally, the switch the ASC X12 Version 5010 standards required of hospitals, physician practices, health plans and claims clearinghouses was set for January 1, 2012. But the CMS announced it would push it back to March 31, 2012.

The announcement came after a significant amount of protest within the medical industry and their inability to be ready to make the upgrade from the Version 4010 standards currently in use. The CMS respond accordingly.

According to the CMS, its decision to push back their enforcement deadline was “based on industry feedback revealing that, with only about 45 days remaining before the January 1, 2012 compliance date, testing between some covered entities and their trading partners has not yet reached a threshold whereby a majority of covered entities would be able to be in compliance by January 1.”

The switch to the Version 5010 standards is consider a necessary precursor to adoption of ICD-10. Those who do not comply by the deadline face hefty penalties. According to the CMS website, “The HIPAA legislation permits civil monetary penalties of not more than $1.5 million per calendar year for a violation of an identical provision.”

According to a Medical Group Management Association member survey, only one in 50 physician group practices has completely implemented the software changes  that are necessary to make the switch to Version 5010.