CMS delays 5010 enforcement, again

The CMS will not begin enforcing the mandated move to Version 5010 transaction standards for an additional three months, until after June 30.

The deadline for the switch to the 5010 standards was Jan. 1. In November, the CMS announced that although it was not changing the actual deadline for complying with the standards, it would not initiate enforcement action until March 31.

On Thursday, the CMS' Office of E-Health Standards and Services said no action will be taken against noncompliant medical practices, hospitals and other healthcare entities through June 30. The agency's e-mailed announcement stated that the industry is making "steady progress" in the conversion, and it noted that the Medicare Fee-for-Service program was successfully processing 70% of Medicare Part A claims and more than 90% of Part B claims in the 5010 format. Also, according to the announcement, commercial plans have been reporting "similar numbers;" state Medicaid agencies are "showing progress," and that 98% compliance is expected before the July 1 enforcement start date.

The Office of E-Health Standards and Services "is aware that there are still a number of outstanding issues and challenges impeding full implementation," the announcement stated. "OESS believes that these remaining issues warrant an extension of enforcement discretion to ensure that all entities can complete the transition."

The CMS went on to say that it is urging industry collaboration to resolve remaining problems and that it will partner with industry groups to expand technical assistance.

The CMS released the announcement shortly after the MGMA-ACMPE posted a letter it sent to Marilyn Tavenner, CMS acting administrator, in which the group asked for more time and more help from health plans and clearinghouses in identifying errors in Version 5010 claims.

"While we appreciate the agency's initial enforcement postponement and willingness to work with us on individual member concerns, we strongly urge the (CMS) to extend the current discretionary enforcement delay to allow physician practices to receive payments in a timely manner and ensure that they can continue to treat patients," MGMA President and CEO Dr. Susan Turney said in the letter.