5010 Enforcement Grace Period Extended Again

UPDATE: The Centers for Medicare & Medicaid Services announced March 15 that it will not enforce any HIPAA 5010 violations until June 30, 2012. TMA continues to urge all physicians to work with their practice management system vendors and claims clearinghouses to ensure they are 5010-compliant.


March 31 is the final day of the government's 90-day grace period for enforcement of the Health Insurance Portability and Accountability Act (HIPAA) Version 5010 transaction standards. If you are not already using the 5010 standards, you must start doing so or Medicare, Medicaid, and private insurers will reject your claims.

Physicians have told TMA and the American Medical Association that they are seeing more claims rejected in recent weeks. The conversion to the 5010 standards on Jan. 1 could be the culprit.

Contact the TMA Knowledge Center if you have these issues. Include the name of your practice management software vendor, your clearinghouse, the health plans that are rejecting your claims, and a copy of a claims acceptance report to verify that your claims actually made it from the clearinghouse to the health plan. TMA's Payment Advocacy Department can help if the health plan is causing the delay.

You also may file a complaint on the AMA website. Call AMA at (800) 262-3211 if you need more help.

The TMA 5010 Resource Center includes background information on the issue; questions to ask vendors; contact information for electronic health record (EHR), practice management, and clearinghouse vendors; information on how you can finance upgrades to your existing system or purchase a new systems; and an action plan.

Check the TrailBlazer Health Enterprises and the Texas Medicaid & Healthcare Partnership websites to verify that your vendor is approved for Medicare and Medicaid 5010 claims. Contact your vendor as soon as possible if it is not on the list. TMA suggests contacting commercial carriers directly.

If you are purchasing a new system, it may be a good time to evaluate a companion practice management/EHR system. This allows eligible physicians to participate in the Medicare or Medicaid EHR incentive programs that pay physicians for meaningfully using an EHR.

If you choose to participate, the Texas regional extension centers (RECs) can help you with selection, implementation, and meaningful use. More information about the REC program is available on the TMA website.  


Action, March 15, 2012


Comment on this (Must be logged in to comment)

Add Comment

Text Only 2000 character limit

Looking for more?