Version 5010 enforcement discretion period comes to an end
The Version 5010 enforcement discretion period ended on June 30, 2012, according to PTProducts Online. Beginning on July 1, all non-compliant providers and other healthcare entities, including traveling physical therapists, face possible strict enforcement action under the current Health Insurance Portability and Accountability Act (HIPAA) transaction and code set enforcement process.
All HIPAA-covered healthcare providers and practices were initially required to upgrade to the new ASC X12 Version 5010 and NCPDP Versions D.0 and 3.0 by January 1 of this year. The Centers for Medicare and Medicaid Services (CMS) in Baltimore, Maryland, allowed an enforcement discretion period. This buffer was designed to give the industry more time to upgrade to the new standards for healthcare transactions. Any covered entities who were not compliant with the updated Version 5010/D.0 standards during this grace period did not face enforcement action.
The CMS offered several steps for physical therapists who were having difficulty completing their Version 5010 implementation. The American Physical Therapy Association (APTA) recommended that traveling physical therapists reach out to clearinghouses and take advantage of free or low-cost software. Additionally, they could have contacted financial institutions to establish lines of credit in case of interruptions in claims reimbursements.
According to Virtual Care Provider, Inc. (VCPI), the upgrade in transactions standards constitutes a major undertaking for providers, payers and vendors, which will have a significant impact on the healthcare industry. Experts foresee big changes in business practices and systems at all levels of the industry, from large nationwide health plans to smaller provider offices.
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