EHR, Coding Compliance Deadlines Loom

The Centers for Medicare & Medicaid this week reminded healthcare providers, health plans, clearinghouses, and vendors about looming compliance deadlines for new diagnosis and procedure codes, and updated standards for electronic healthcare transactions.

The first compliance milestone for the Accredited Standards Committee X12 Technical Reports Type 3, Version 005010 (Version 5010) electronic healthcare transaction standards begins on Jan. 1, 2011. By then, HIPAA-covered entities should be ready to test the functionality of practice management and related software featuring Version 5010 standards.

Use of the Version 5010 standards for HIPAA electronic healthcare transactions, including claims, remittance advice, eligibility inquiries, referral authorization, and other administrative transactions, becomes mandatory on Jan. 1, 2012. Version 5010 standards also provide the framework for ICD-10-CM and ICD-10-PCS revised medical data code sets that must be in place on Oct. 1, 2013.

"The Version 5010 standards and ICD-10 codes are necessary steps to facilitate the national transition to an electronic healthcare environment," says CMS Administrator Donald Berwick, MD. "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 healthcare system."

The expanded ICD-10 code sets will support quality reporting, pay-for-performance, bio-surveillance, and other critical activities, and provide terminology for electronic health records. 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/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," says 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."

Also facing a Jan. 1, 2012 installation deadline is the National Council for Prescription Drug Programs Version D.0 standard for retail pharmacy transactions, and NCPDP Version 3.0, the standard for the Medicaid pharmacy subrogation transaction. Small health plans have an additional year and must be compliant with Version 3.0 on Jan. 1, 2013.

To help healthcare 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," says Tony Trenkle, Director of CMS' Office of E-Health Standards and Services.
"All of the information is free and can be downloaded. 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."