CMS Again Stalls Enforcement of 5010 Electronic Transaction Standards

Enforcement Will Begin After June 30

March 20, 2012 02:30 pm News Staff

CMS recently announced that it would once again delay enforcement of physician compliance with the version 5010 transaction standards for the electronic transfer of health information.

According to a March 15 press release(, the new timeline means the agency's Office of E-Health Standards and Services (OESS) will hold off initiating any enforcement action against physicians and other affected entities who are not using the 5010 transaction standards until after June 30.

Physicians should note that the agency did not rescind the Jan. 1, 2012, compliance deadline, and CMS is urging physicians to take advantage of the additional three months this latest delay provides to "complete outstanding implementation activities, including software installation, testing and training."

The 5010 version of the transaction standards, which replaces the 4010/4010A standards, was mandated by the Health Insurance Portability and Accountability Act. This is the second time CMS has delayed enforcement of the standards. In mid-December, the agency announced it would not initiate enforcement action until March 31, but it decided physicians and others need more time to prepare.

According to CMS, health plans, clearinghouses, software vendors, and physicians and other health care professionals are making "steady progress" with the transition to the 5010 standards.

In fact, according to CMS, its Medicare fee-for-service program reports that currently, more than 70 percent of all Part A claims -- and more than 90 percent of Part B claims -- are being successfully received and processed in the 5010 version format.

The OESS predicts a 98 percent compliance rate across the entire health care industry by the June 30 deadline.

In the meantime, Medicare administrative contractors (MACs) intend to continue their close collaboration with clearinghouses, billing vendors and physicians in the event any of those players needs assistance with submitting and receiving electronic transactions that are 5010 compliant.

Physicians and others who need help from a MAC and who are having difficulty getting in touch with one, can e-mail a message to CMS. Put "5010 Extension" in the subject line, and then explain the problem.