Also stresses need to prepare for 2013 compliance date for ICD-10 code sets
The Centers for Medicare & Medicaid Services (CMS) today issued a reminder to health care providers, health plans, clearinghouses, and vendors about the approaching compliance dates for a new generation of diagnosis and procedure codes and updated standards for electronic health care transactions.
The first compliance milestone for transition to the Accredited Standards Committee X12 Technical Reports Type 3, Version 005010 (Version 5010) electronic health care transaction standards is fast approaching. Beginning in January 2011, entities covered under the Health Insurance Portability and Accountability Act (HIPAA)should be ready to test with their trading partners the functionality of the entities’ practice management and/or other related software featuring Version 5010 standards.
Use of the Version 5010 standards for HIPAA electronic health care transactions, including claims, remittance advice, eligibility inquiries, referral authorization, and other administrative transactions, will be mandatory on Jan. 1, 2012. The Version 5010 standards also provide the framework needed for use of the revised medical data code sets (ICD-10-CM and ICD-10-PCS), that must be implemented on Oct. 1, 2013.
“The Version 5010 standards and ICD-10 codes are necessary steps to facilitate the national transition to an electronic health care environment,” said CMS Administrator Donald Berwick, M.D. “Transitioning to the Version 5010 transaction standards in 2012, and to the ICD-10 codes in 2013, will help accelerate the widespread adoption of health information technology and move the nation toward a more efficient, quality-focused health care system.”
The Version 5010 standards for administrative transactions provide the clarity needed to develop the administrative transactions operating rules stipulated in the Affordable Care Act, and will create an essential framework for use of the ICD-10 codes. The greatly expanded ICD-10 code sets will support quality reporting, pay-for-performance, bio-surveillance, and other critical activities, and provide a rich terminology for use of electronic health records (EHRs). The ICD-10 code sets will also link to the standards and certification criteria for demonstrating “meaningful use” of certified EHR technology under the Medicare and Medicaid EHR incentive program.
“We have many information resources and outreach activities in place to facilitate compliance with both Version 5010 and ICD-10, and we are proactively working with partner organizations to ease the transition,” said Marilyn Tavenner, CMS principal deputy administrator, “Beginning January 2011, the Medicare Fee for Service program will be ready to test Version 5010 transaction standards with its external partners, and we anticipate that other industry segments will be poised to follow suit.”
In addition to the approaching transition to Version 5010, use of the National Council for Prescription Drug Programs (NCPDP) Version D.0 standard for retail pharmacy transactions, and NCPDP Version 3.0, the standard for the Medicaid pharmacy subrogation transaction, also must be implemented on Jan. 1, 2012. Small health plans, however, have an additional year and must be compliant with Version 3.0 on Jan. 1, 2013. Subrogation is the process by which state Medicaid agencies recoup funds for payments they have made for pharmacy services for Medicaid recipients, in cases where another third party payer has primary financial responsibility.
To help health care providers, health plans, clearinghouses, and vendors work toward the compliance dates for Version 5010 and ICD-10 — and avoid delays in claims processing and payment — CMS has been conducting ongoing industry outreach and education, and, most notably, has revised its ICD-10 Web site. “We have refocused our efforts on making available a full range of resources, including fact sheets, timelines, videos and other materials, at our ICD-10 Web site,” said Tony Trenkle, Director of CMS’ Office of E-Health Standards and Services. “All of the information is free and can be downloaded from http://www.cms.gov/ICD10. We have also worked closely with our industry and stakeholder partners to push out important messages through their respective communications vehicles, and we have identified their Version 5010/ICD-10 materials and provided links to their publically accessible Web sites.”
Visitors to the CMS ICD-10 Web site also can opt in to e-mail alerts and listservs that automatically deliver e-mail messages whenever information updates are posted to the Web site, and/or may choose to receive specific Version 5010/ICD-10 e-mail reminder messages.
Final regulations adopting Version 5010, NCPDP Version D.0 and Version 3.0, and ICD-10 were published on Jan. 16, 2009, and may be viewed under 
“Health and Human Services Department” in the table of contents for that date’s Federal Register, found here: http://www.access.gpo.gov/su_docs/fedreg/a090116c.html.
A Jan. 15, 2009 fact sheet describing both rules may be viewed at http://www.cms.gov/apps/media/press/factsheet.asp?Counter=3407
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