CMS Emphasizes Need for All HIPAA-Covered Facilities to Prepare for Version 5010 Change

The Centers for Medicare and Medicaid Services is emphasizing the need for more health-care facilities covered by the Health Insurance Portability Accountability Act (HIPAA) to work on testing, the move into production for the Version 5010 change and to work with their Medicare Administrative Contractor (MAC) to initiate testing.

MS announced last month that it would not initiate enforcement action against any HIPAA covered entity that is noncompliant with Version 5010, NCPDP, NCPDP D.0 and 3.0 standards until 90 days after the Jan. 1, 2012 compliance date.

“Although compliance will not be enforced for Version 5010 until April 1, 2012, it is important to continue to take the necessary steps to complete your transition to Version 5010 as soon as possible,” the agency stated in a Dec. 21, 2011, press release.

Although Medicare Fee-For-Service (FFS) is recognizing significant increases in 5010 production transactions the past few months, CMS noted that many submitters have “tested but
not taken the step to move into production for 5010 and D.0. In addition, there are many submitters that have not yet initiated testing with their Medicare Administrative Contractor (MAC).”

To address those facilities still working toward compliance, Medicare FFS plans to take the following steps for submitters and receivers of Medicare Part B and Durable Medical Equipment (DME) transactions:

• In December 2011, submitters and receivers that have tested and been approved for 5010/D.0 will be notified that they have 30 days to cut over to the 5010/D.0 versions.
• Submitters and receivers that have not started testing transmissions will be notified in December 2011 that they must submit their transition plans and timelines to their MAC within 30 days.
• MACs will notify the submitters and receivers, but submitters/receivers have the responsibility to notify the providers they service.

“Submitters and receivers of Medicare Part A transactions will follow the same action plan starting 30 days after Part B and DME,” stated the CMS press release.