Updated on: March 16, 2016

No More 5010 Enforcement Extensions for 5010 Testing, Advises CMS Director

Original story posted on: March 20, 2012

Don’t expect another extension for 5010 compliance, advises Denise Buenning, director of the administrative simplification group at CMS’ Office of E-Health Standards and Services.

“Once this current period expires, there won’t be a predisposition to another extension,” said Buenning during an interview on yesterday’s Talk-Ten-Tuesday, ICD10monitor.com’s live weekly podcast. Buenning was referring to an announcement made on March 15, 2012 when CMS stated that it would not initiate enforcement of 5010 HIPAA electronic transaction standard for another three months, through June 30, 2012. On Nov. 17, 2011, CMS announced a 90-day extension period from the original enforcement date of Jan. 1, 2012.


According to Buenning, this second extension gives HIPAA-covered entities time to resolve their issues. She said an enforcement extension means that there’s no penalty for those who continue to use the 4010.

During the March 20 podcast, listeners were asked the following question on the weekly poll: How does this second reprieve from CMS regarding 5010 enforcement impact your organization?

The good news is that almost 60 percent of those listening say they are ready for 5010, while 18 percent could “use a little more time”—a fact that CMS’s industry interactions also have revealed. Just 11 percent have a lot more to do and welcome the delay while the 5010 does not apply to the remaining 12 percent.


Buenning reported that vendors “are having the hardest time keeping up” with completing installations and providing proper training. This, in turn, slows down providers’ progress, and, she says, “We hear that there are long wait times.”

Nonetheless, CMS itself is making progress and encourages those who are ready to ensure that their testing is robust and complete. Buenning indicated that the agency will be providing “enhanced technical assistance” to covered entities and collaborating with organizations such as the Workgroup on Electronic Data Interchange (WEDI) and Medical Group Management Association (MGMA), which are “gathering intelligence on provider issues.” With this information, CMS will revise the FAQs (frequently asked questions) on its website and also plans to establish an online mailbox for 5010 issues.


The Other Side of the Coin


Stanley Nachimson, principal of Nachimson Advisors, considers the extension of the 5010 enforcement “a little disappointing,” remarking that the “industry hasn’t done a great job” in this implementation. As he notes, the switch to the 5010 was announced in January 2009 but, “three years still wasn’t enough time” to get ready. “We need to go back and see why industry isn’t meeting its deadlines.”


Nachimson acknowledges that the delay gives those who aren’t ready an opportunity to evaluate and fine-tune their processes, to ensure that they’re still sending claims and receiving payments, and to resolve all of the issues in between. Now they can fix their problems without having to worry about CMS’s enforcement action.


However, CMS also is sending a message to the industry that “the deadline isn’t really the deadline, which makes planning for the long-term difficult. Currently, “people are focusing on the 5010 and not thinking of the future efforts needed,” he says.


As Buenning mentioned, one such effort is to thoroughly test systems—an early recommendation made by CMS and other organizations that covered entities didn’t take seriously. This is why, notes Nachimson, problems have occurred. For example, some health plans tested 25 claims, which moved through the system fine. But such a small number of claims do not begin to address the variety of possible scenarios that might occur.

From Nachimson’s viewpoint, covered entities can avoid further problems by realizing that “it’s an industry partnership,” and “you’re only as strong as your weakest link.” All of the participants need to see that this is “more than a compliance effort; it’s a better way to do business.”


Continue to Focus on Future

While some of the industry focuses on the 5010 transition, QuadraMed advises its clients to continue to plan for the implementation of the ICD-10 system, according to Bonnie Cassidy, the company’s vice president of HIM product management and the 2011 president of the American Health Information Management Association (AHIMA).

Her advice remains solid: “Stay the course and move forward as if we don’t have a delay. Review and adjust if needed. People, processes, and technology should be the focus as well as appropriate and accurate clinical content.”

Some of her clients are even going beyond I-10 and taking the time to become experts in areas that they haven’t so far had enough time to address. Such areas include value-based purchasing, quality reports, and meaningful use and the electronic health record.

Another area of forward-thinking is computer-assisted coding (CAC) which, during this time of transition, is getting a second look.

Mark Morsch, vice president of technology at A-Life Medical, now part of OptumInsight, joined Talk Ten Tuesday and highlighted some of the technology’s benefits sure to the covered at the CAC summit in Baltimore on April 18. Even if the implementation date for I-10 changes, he says, health information management (HIM) organizations need to make processes and systems become more efficient and productive with the end result being more accurate coding.


“With CAC, coder productivity can increase because the burden of code assignment is taken up by technology. The coder becomes a validator of correct assignments, which offsets loss of productivity during ICD-10 transition,” Morsch says. “CAC is the technology that will allow folks to mitigate the risk of denials.”


Janis Oppelt

Janis keeps the wheel of words rolling for Panacea®'s publishing division. Her roles include researching, writing, and editing newsletters, special reports, and articles for RACMonitor.com and ICD10Monitor.com; coordinating the compliance question of the week; and contributing to the annual book-update process. She has 20 years of experience in topics related to Medicare regulations and compliance.