The December issue of the print Bulletin and a recent eBulletin alerted AAO members to the fact that the new HIPAA Version 5010, which applies to covered entities including dental practices, goes into effect January 1, 2012. The Center for Medicare and Medicaid Services (CMS), Office of E-Health Standards and Services (OESS) has now announced that, although compliance with HIPAA 5010 standards is required for covered entities effective January 1, 2012, enforcement action will not be taken until April 1, 2012.

The OESS opted to delay enforcement after learning that testing between some covered entities and their trading partners has not yet reached a level where all parties would be able to be compliant by January 1. In addition, reports have indicated that many covered entities still  have pending software upgrades. If your office or practice management software vendor has not implemented and become prepared to use Version 5010 standards, your office runs the risk of adding significant cost, complexity and payment delays to its business processes.

During the 90-day grace period, OESS will continue to accept complaints associated with compliance with Version 5010 transaction standards. Covered entities that are the subject of complaints must produce evidence of either compliance or a good faith effort to become compliant if requested.

HIPAA 5010 standards have been developed to serve as the foundation for supporting future ICD-10 codes sets, to support the National Provider Identifier and to provide consistency across all transactions. Your office must adhere to the HIPAA 5010 transaction standards if you file claims electronically. If you have not already contacted your practice management software vendor, please do so quickly to ensure that your claims system is ready to support the new HIPAA 5010 standards by January 1, 2012.