Concern persists for HIPAA 5010, ICD-10 non-compliance fines

Although no official word has been handed down regarding exactly what fines our federal government may slap against healthcare organizations that fail to comply with HIPAA 5010 or ICD-10, it appears likely that there will be fines, and they will be sizable.

Gale Scott, HIPAA transaction compliance administrator at Tampa General Hospital, said in a Webinar about starting the HIPAA 5010 migration last year that a CMS unit could conduct “random audits to make sure you're compliant,” and even though CMS has not outlined specifics of potential fines, “there's every indication they're headed that way.”

[Related: PwC places ICD-10 among top health issues for 2011. See also: 9 ways ICD-10 will better the business of healthcare.]

Dennis Winkler, Blue Cross Blue Shield Michigan's director of technical program management speculated to ICD10Watch that “once it goes through, there will be huge, huge fines for not being compliant.”

Scott and Winkler are not just voices of dissent. Rather, 58 percent of ICD10Watch readers indicated in a poll that they are worried about non-compliance penalties. This poll garnered 36 total votes.

Fines are not the only problem facing health entities that fail to comply; actual payment or reimbursement will inevitably prove problematic without submitting claims in the proper formats.

That reality, the fact that their cups are running over with more immediate projects, and a lack of information about the fines all may be more worrisome to the 42 percent of readers who voted that “no,” they're not concerned with any fines that may he handed out.

“We have no idea what compliance issues will be applied,” says Frank Balco, director of payer solutions at HCL Technologies during a Webinar about ICD-10 success factors. “Our current administration has made it clear that compliance fines are a revenue source.”