On November 17, the Centers for Medicare and Medicaid Services’ Office of E-Health Standards and Services (OESS) announced that it will not enforce compliance with the ASC X21 Version 5010 (a.k.a. ANSI 5010) standards until March 31, 2012. However, the January 1, 2012 ANSI 5010 compliance date remains in effect. Essentially the OESS, which enforces compliance with HIPAA transaction and code set standards (i.e., ANSI 5010), is granting a grace period to ensure that the industry has fully tested for 5010 before it takes enforcement action against HIPAA-covered entities that are not compliant. A HIPAA-covered entity is any healthcare provider that conducts certain transactions in electronic format as well as clearinghouses and health plans.
CMS made this decision with 45 days remaining until the January 1, 2012 compliance date because:
- Testing by the covered entities and their trading partners had not reached a threshold whereby a majority of covered entities would be compliant by January 1, 2012.
- The number of submitters and volume of transactions and testing data used as indicators of 5010 readiness have been low across some industry sectors.
- Many covered entities are still completing software upgrades.
What does this mean for Lytec users?
To reiterate, the compliance date for 5010 has not changed. Per CMS, payers that are certified on 5010 can enforce and require 5010-formatted claims beginning January 1, 2012.
CMS encourages covered entities to continue work to be 5010-compliant by January 1, 2012.
Lytec 2011 is a 5010-compliant practice management product for independent and group practices.
If your practice has plans to upgrade to Lytec 2011, please continue with the upgrade as planned.
If you have not purchased or scheduled your upgrade to Lytec 2011, please do so as soon as possible to ensure that your practice is ready to submit 5010-compliant claims when your payers are ready to accept them.
What does your practice need to do?
Once you are live with Lytec 2011, we can help you work with your clearinghouse to test your 5010 transactions. In addition, you are responsible for making updates to your current production environment to ensure your smooth transition to 5010 production standards.
