Home Health & Hospice Week

Not a deadline shift: CMS stresses in its Nov. 17 statement that the 5010 compliance date remains Jan. 1, 2012. However, the agency will not penalize providers that aren't using 5010 until after the new 90-day "discretionary enforcement period" ends in March, as long as they can demonstrate that they are working toward 5010 use.

"If requested, covered entities that are the subject of complaints must produce evidence of either compliance or a good faith effort to become compliant with the new HIPAA standards during the 90-day period," CMS says in its statement.

What to expect: "It is unclear what will ultimately happen," NAHC tells its members. "Pro-viders need to work with trading partners to determine what they want and are ready for. It is unlikely that payers will be required to accept both the 4010A and the 5010, although they might choose to," the trade group advises.

If a payer will accept only version 5010 but the provider can support only version 4010A, the claim would have to be converted by a clearinghouse, NAHC suggests.

Why: The CMS Office of E-Health Stan-dards and Services (OESS), which is responsible for HIPAA code set compliance, made the change because "testing between some covered entities and their trading partners has not yet reached a threshold whereby a majority of covered entities would be able to be in compliance," CMS explains. "The number of submitters, the volume of transactions, and other testing data used as indicators of the industry's readiness to comply with the new standards have been low across some industry sectors. OESS has also received reports that many covered entities are still awaiting software upgrades."

Even though you're getting a break on the 5010 deadline, you should still work to get into compliance as soon as possible, suggests Matthew Hawkins, CEO of software vendor Vitera Health-care Solutions in Tampa, Fla. Taking the time now to upgrade to a 5010-compliant system reduces risk associated with scheduling system upgrades and provides time to certify that systems work appropriately, Hawkins says in a release. "It also puts responsibility on payors to facilitate the 5010 compliant transactions," he adds.

You should also consider becoming "ICD-10 enabled" at the same time that you install updates for 5010, Hawkins adds. "Why perform the 5010 upgrade now and then the ICD-10 upgrade in the future?" he asks.

Note: To get more on CMS's latest 5010 developments, tune in to the agency's free Dec. 7 conference call on the topic. Call in information is at www.CMS.gov/Versions5010andD0. And CMS's deadline announcement is at http://www.cms.gov/ICD10/Downloads/CMSStatement5010EnforcementDiscretion111711.pdf.