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5010 Compliance Period

SuperCoder Posted Tue 27th of November, 2012 10:07:28 AM

When is the CMS 5010 going to be implemented? Is it delayed further by CMS after Jan. 1st 2012?

SuperCoder Answered Tue 27th of November, 2012 11:35:37 AM

CMS first planned to require the 5010 format Jan. 1, but last November it announced a three-month delay, CMS notes in a message to providers. Now CMS has put off 5010 enforcement another three months, to June 30.

Providers and other claims submitters "have been making steady progress," CMS said in its announcement. "The Medicare Fee-for-Service (FFS) program is currently reporting successful receipt and processing of over 70 percent of all Part A claims and over 90 percent of all Part B claims in the Version 5010 format."

But some technical glitches are still plaguing the new format. "There are still a number of outstanding issues and challenges impeding full implementation," CMS admits. CMS’s Office of E-Health Standards and Services "believes that these remaining issues warrant an extension of enforcement discretion to ensure that all entities can complete the transition."

Example: Providers who haven’t received an appropriate EDI authorization to use 5010 can’t submit the new claim format, the agency says in a new factsheet troubleshooting 5010 processing problems.

"It’s important that all HIPAA-covered entities continue to take the necessary steps to complete the upgrade to Version 5010 as soon as possible," CMS urges in a message to providers.

Stay Tuned for Help

CMS plans "to expand technical assistance opportunities and eliminate remaining barriers," the agency pledges.

You can find a link to the factsheet, "Important Update Regarding Version 5010/D.0 Implementation," at www.cms.gov/Regulations-and-Guidance/HIPAA-Administrative-Simplification/Versions5010andD0/.

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