Don't Stop HIPAA 5010 Change

Despite the government's announcement [PDF] that it is delaying enforcement of the HIPAA 5010 electronic claims standards for 90 days, the Texas Medical Association recommends physicians continue planning to begin using the new standards on Jan. 1 if you want to get your claims paid.

The Centers for Medicare & Medicaid Services (CMS) said it will not enforce the standards until March 31, 2012, but said the compliance deadline is still Jan. 1. CMS said it delayed enforcement because many of the covered entities would not be ready by Jan. 1. 

Rodney McDonald in the CMS Dallas Regional Office told TMA in an email that the announcement "means that everyone will still be required to use the 5010 format beginning January 1, 2012, in order to carry out and complete transactions. However they will not face any enforcement actions by the CMS Office of E-Health Standards and Services if they are not compliant on that date."

Thus, TMA advises physicians who have not completed the switch to do so by Jan. 1 to avoid the possibility of having private insurers, Medicare, and Medicaid reject their claims because they did not use the new standards.

TMA will post more information on the CMS announcement and its impact in the 5010 Resource Center on the TMA website. The resource center includes background information on the issue; questions to ask vendors; contact information for electronic health record, 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.

TMA conducted a Tele-Town Hall Meeting on the new transaction standards in September. If you missed it, you may listen to it via the TMA weblog Blogged Arteries.

Moderated by TMA President C. Bruce Malone, MD, the recording features expert TMA presentations on the details of the new standards, how to prepare to upgrade your practice management or electronic health record systems, how to develop an action plan, and the impact on your business functions.

For more information on this and other pending compliance deadlines and how TMA can help you meet them, log on to TMA's Calendar of Doom

Action Special Issue, Nov. 17, 2011

Last Updated On

May 25, 2016