Statute and Regulations

ICD-10 Final Rule

On December 7, 2011, CMS released a final rule updating payers' medical loss ratio to account for ICD-10 conversion costs. Effective January 3, 2012, the rule allows payers to switch some ICD-10 transition costs from the category of administrative costs to clinical costs, which will help payers cover transition costs.

On January 16, 2009, the U.S. Department of Health and Human Services (HHS) released the final rule mandating that everyone covered by the Health Insurance Portability and Accountability Act (HIPAA) implement ICD-10 for medical coding.

In a related final rule released the same day, HHS mandated that transaction standards for all electronic health care claims must be upgraded to Version 5010 from Version 4010/4010A by January 1, 2012.  As of January 1, 2012 all HIPAA covered entities must be compliant with Version 5010.