On January 15, 2009 the Department of Health and Human Services (HHS) released two eagerly awaited final rules that will facilitate adoption of the ICD-10 code sets and the next generation of standards for HIPAA electronic transactions (Version 5010).
The first replaces the current ICD-9-CM code sets used for reporting diagnosis codes and inpatient hospital procedures with the greatly expanded ICD-10 code sets. The rule also extends the compliance date from October 1, 2011 to October 1, 2013, allowing covered entities nearly five years from the date of publication to achieve compliance. HIPAA covered entities (which include health care providers, insurance plans, and clearinghouses that transmit electronic health information in connection with a transaction for which a standard has been adopted by HHS) are required to use the expanded ICD-10 code sets
In addition to increasing the number of codes from 17,000 to more than 155,000, adoption of ICD-10 is expected to achieve the following:
- support Medicare’s value-based purchasing initiative and antifraud and abuse activities by accurately defining services and providing specific diagnosis and treatment information
- provide the precision needed for a number of emerging uses such as pay-for-performance and biosurveillance (the automated monitoring of information sources that may help in detecting an emerging epidemic, whether naturally occurring or as the result of bioterrorism)
- support comprehensive reporting of quality data
- ensure more accurate payments for new procedures, fewer rejected claims, improved disease management and harmonization of disease monitoring and reporting worldwide
- allow the United States to compare its data with international data to track the incidence and spread of disease and treatment outcomes (note that the United States is one of the few developed countries not using ICD-10)
These changes will also improve claims processing and payment, as well as facilitate the implementation of electronic health records.
The second final rule adopts the following:
- an updated X12 standard, Version 5010, for certain electronic healthcare transactions
- an updated version of the National Council for Prescription Drug Programs standard, Version D.0, for electronic pharmacy-related transactions
- a standard for Medicaid pharmacy subrogation transactions
Version 5010 includes updated standards for claims, remittance advice, eligibility inquiries, referral authorization, and other administrative transactions. Version 5010 also accommodates the use of the ICD-10 code sets, which are not supported by Version 4010/4010A1, the current X12 standard. The ruling has a set compliance date of January 1, 2012, which allows covered entities nearly three years for implementation.
Both regulations were published in the Federal Register on January 16, 2009. Visit the Federal Register website to learn more.
