Acknowledging that many physicians and billing entities still aren't ready, federal officials are giving physicians three more months before it begins enforcing the use of Health Insurance Portability and Accountability (HIPAA) 5010 transaction standards. The new deadline is June 30.
The new transaction standards took effect Jan. 1, but the Centers for Medicare & Medicaid Services (CMS) gave physicians until March 31 to begin using them. On March 15, CMS issued a statement that said it pushed back the deadline again because there still are problems with full implementation of the standards and it "believes that these remaining issues warrant an extension of enforcement discretion to ensure that all entities can complete the transition."
If you are already using the standards to file claims, fine. If not, continue preparing to start using them by June 30 or Medicare, Medicaid, and private insurers will reject your claims.
The TMA 5010 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.
Check the TrailBlazer Health Enterprises and the Texas Medicaid & Healthcare Partnership (TMHP) 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.
CMS said TrailBlazer Health Enterprises will continue working with clearinghouses, billing vendors, or health care professionals who need help submitting and receiving 5010 compliant transactions. Issues related to implementation problems with Medicaid may be sent to Medicaid5010@cms.hhs.gov.