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CMS announces delay in enforcement for Version 5010 standards
e-Reports, Dec. 5, 2011
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TRIAGE: INTERPRETING, EXPLAINING IMPORTANT NEWS FOR YOUR PRACTICE Untitled document

If you complete transactions electronically – such as submit claims or check eligibility – you may have a little more time to comply with Version 5010 transaction standards.

While affirming the compliance date of Jan. 1, 2012, the Centers for Medicare & Medicaid Services (CMS) announced Nov. 17 that it would not enforce action for another 90 days, until March 31.

You are required to upgrade from Version 4010/4010A to Version 5010 transaction standards if you are a “covered entity” under the Health Insurance Portability and Accountability Act (HIPAA). Covered entities conduct Medicare business and transmit personal health data online. Conversion to the 5010 transaction set is an integral step toward successful ICD-10 transition, which is still set for Oct. 2, 2013.

The enforcement delay was deemed necessary because many are still awaiting software upgrades. But be warned that federal agencies will still accept complaints about non-compliance during the 90-day delay.

Here’s some sound advice
CMS advises it is essential to test with business partners, both internally and externally, prior to the Version 5010 deadline. “Such testing helps assure all trading partners are able to send and receive compliant transactions effectively in advance of the transition deadline,” said Jeri Biedenkopf, R.N., ISMA practice advisor.

Take action now to avoid problems with submitting claims for reimbursement in 2012. If you have not yet begun external testing, make use of the following risk mitigation strategies:

  • Establish a line of credit to help cover potential cash flow disruptions from delayed reimbursement of claims.
  • Encourage vendors to take action now and establish a communication plan. It’s best to communicate with vendors and trading partners regularly.
  • Contact a clearinghouse for assistance. A clearinghouse ensures claims smoothly transition between practices and payers and can serve as a translator for non-compliant transactions from a Version 4010/4010A to Version 5010 system. If you are concerned that your internal systems may not be ready by Jan. 1, use a clearinghouse already prepared to process Version 5010 claims to ensure reimbursements are not interrupted while you bring your own systems into compliance.
  • Take advantage of available resources. Many different sources offer valuable information to streamline your Version 5010 transition. CMS offers several tools to help you plan and execute your transitions to Version 5010 and ICD-10. Find them on the CMS website. Also, professional societies and organizations offer resources to help you.

“Pay particular attention to the caution about establishing a line of credit,” noted Biedenkopf. “This may prove to be critically important to the financial viability of your practice as we move through this transition process.”

Find the latest news and resources to help you prepare for Version 5010 and ICD 10 here.

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