HIPAA Enforcement Discretion Period Extended to June 30, 2012

CMS’ Office of E-Health Standards and Services (OESS) announced that it will not initiate enforcement action against any covered entity that is required to comply with the updated transactions standards adopted under the Health Insurance Portability and Accountability Act of 1996 (HIPAA): ASC X12 Version 5010 and NCPDP Versions D.0 and 3.0 for an additional three (3) months, through June 30, 2012.

OESS is aware that there are still a number of outstanding issues and challenges impeding full implementation of these versions. OESS believes that these remaining issues warrant an extension of enforcement discretion to ensure that all entities can complete the transition. OESS expects that transition statistics will reach 98 percent industry wide by the end of the enforcement discretion period on June 30, 2012.

Health plans, clearinghouses, providers and software vendors have been making steady progress in installing and working with these updates. The Medicare Fee-for-Service (FFS) program is currently reporting successful receipt and processing of over 70 percent of all Part A claims and over 90 percent of all Part B claims in the Version 5010 format. Commercial plans are reporting similar numbers. State Medicaid agencies are showing progress as well, and some have made a full transition to Version 5010.

CMS urges covered entities to collaborate more closely on appropriate strategies to resolve remaining problems. OESS is stepping up its existing outreach to include more technical assistance for covered entities. OESS is also partnering with several industry groups as well as Medicare FFS and Medicaid to expand technical assistance opportunities and eliminate remaining barriers, and more will be forthcoming on these efforts.

The American Medical Association reported in its Amednews.com on March 19th that the delay in the implementation of the ICD-10 code set would give physicians needed time to work on becoming compliant with other regulations such as HIPAA 5010 and the Administrative Simplification of HIPAA provision, as well as meaningful use.