CMS Delays Enforcement of 5010 Transaction Standards to March 31

Physicians Still Held to Jan. 1 Compliance Deadline

December 13, 2011 04:55 pm News Staff

CMS recently announced it will exercise a 90-day period of enforcement discretion regarding the transition by physicians and other entities to the version 5010 format( for the electronic transfer of health information. The new timeline pushes the enforcement deadline( to March 31, but Cynthia Hughes, C.P.C., an AAFP coding and compliance specialist, cautions family physicians against misconstruing CMS' message.

"The Jan. 1, 2012, compliance deadline for practices to begin using the 5010 transaction standards to send and receive electronic health information remains in place, and physicians should not slow down their transition efforts," said Hughes.

The 5010 version of the transaction standards was mandated by the Health Insurance Portability and Accountability Act, or HIPAA, and replaces the 4010/4010A transaction standards.

According to a CMS statement(, the agency based its enforcement decision on industry feedback that a number of organizations and their trading partners would not be able to finalize system upgrades in time to meet the Jan. 1 deadline.

However, said Hughes, physicians need to know that from January through March, CMS will continue to accept complaints lodged against practices that are not compliant with the 5010 transaction standards.

"HIPAA regulations say that physicians must be submitting in the 5010 format by Jan. 1, 2012, or the Office of E-health Standards and Services -- the enforcement body -- may investigate why the practice is in violation of HIPAA," said Hughes. "The practice then must show that it is making a good-faith effort to comply with the new HIPAA standards during the 90-day grace period."

Although no civil or monetary penalties will be assessed from January to March, Hughes urged family physicians to avoid unnecessary paperwork and hassle by focusing their efforts on meeting the Jan. 1 deadline.

The biggest concern for physicians is that they need to be able to send and receive claims in the new 5010 format to avoid cash flow problems in 2012, said Hughes.