CMS Releases Fact Sheet on Preparing for the HIPAA 5010 Transition

CMS has released a fact sheet to help health care providers prepare for the transition to HIPAA 5010 transaction sets, CMIO reports (Byers, CMIO, 3/26).


HIPAA 5010 standards regulate the transmission of certain health care transactions among hospitals, physician practices, health plans and claims clearinghouses. Converting to the HIPAA 5010 standards is seen as key to the larger switch from the ICD-9 clinical coding system to the ICD-10 system.

CMS recently announced that it would delay the enforcement date for the HIPAA 5010 transition until June 30. The latest delay came after CMS pushed back the enforcement date from Jan. 1 to March 31 (iHealthBeat, 3/15).

Recommendations From Fact Sheet

In the fact sheet, CMS recommended that health care providers prepare for the HIPAA 5010 transition by:

  • Creating a transition plan;
  • Communicating regularly with software vendors and encouraging them to be proactive in avoiding reimbursement problems;
  • Establishing a line of credit to cover potential cash flow disruptions;
  • Seeking assistance from a claims clearinghouse to ensure the smooth transmission of claims between medical practices and insurers (CMIO, 3/26); and
  • Using no-cost software available to Medicare fee-for-service providers from Medicare Administrative Contractors (Terry, FierceHealthIT, 3/23).
Kel Mohror
One massive cause of slow implementation and adoption of HIT is the lack of consistent placement by CMS of the documents it generates. "Fact Sheet on Preparing for the HIPAA 5010 Transition" is an example. At the CMS "Versions 5010 & D.0 & 3.0- Educational Resources" web page, the "Fact Sheet" is not listed in the "Downloads" nor the "Related Links Inside CMS" sections. Unless a provider habitually monitors iHealthBeat, CMIO, or other publication, s/he would have no idea to search for the "Fact Sheet" in the CMS ICD-10 page. For consistency (rather than creating "make work,") CMS should place a link to the "Fact Sheet" at the "Versions 5010 & D.0 & 3.0 > Educational Resources" page as well as the ICD-10 page. This is not "brain surgery." Time lost in searching for compliance knowledge could be better-used in providing patient care.

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