Content Header Image

ICD-10 Implementation Compliance Date Delayed Until 2014

by , Published On: Apr 15, 2011Updated On: Aug 24, 2012

The transition deadline for the International Classification of Diseases, 10th Edition (ICD-10) diagnosis and procedure codes system has been delayed until Oct. 1, 2014, according to a final rule announced today by Kathleen Sebelius, secretary of the U.S. Department of Health and Human Services (HHS).

The final rule also: 

  • Adopts a standard for a unique health plan identifier (HPID).
  • Adopts a data element that would serve as an “other entity” identifier (OEID).
  • Adds a National Provider Identifier (NPI) requirement.

HHS said it believes the change in the compliance date for ICD-10 would allow providers more time to prepare and fully test their systems to ensure a smooth and coordinated transition among all industry segments. 

Many provider groups have expressed serious concerns about meeting the 2013 compliance date because of implementations issues surround Version 5010 standards.

Who is affected by the ICD-10 transition?

Everyone covered by the Health Insurance Portability and Accountability Act (HIPAA) is affected. 

According to the Centers for Medicare and Medicaid Services (CMS), ICD-10 codes must be used on all HIPAA transactions, including outpatient claims with dates of service, and inpatient claims with dates of discharge on and after Oct. 1, 2014. 

If providers do not use the new ICD-10 codes, claims and other transactions may be rejected, and the claims may need to be resubmitted with the ICD-10 codes. This could result in delays in reimbursement, so it is important to start now to prepare for the change over to ICD-10 codes. CMS provides important resources and the HIPPA 5010 and ICD implementation calendar dates.

On Jan. 1, 2012, standards for electronic health care transactions change from Version 4010/4010A1 to Version 5010. These electronic health care transactions include functions like claims, eligibility inquiries, and remittance advices that accommodates the ICD-10 codes. Because of that, the Version 5010 must be in place first before the change to ICD-10 to allow Version 5010 testing and implementation time.

If providers do not conduct electronic health transactions using Version 5010 as of Jan. 1, 2012, delays in claim reimbursement may result. If health plans cannot accept Version 5010 transactions from providers, they may experience a large increase in provider customer service inquiries affecting their operations. Health care providers should prepare now for the Version 5010/ICD-10 transition.

Citing "a number of issues and challenges" with implementation of the Version 5010 format for payment of Medicare claims, the CMS has announced in March that enforcement will be delayed until after June 30, 2012.

LeadingAge ICD-10 Webinar With CMS Available Free to Members: Recording and PPT presentation. Once there click on “2011 Audio Conferences”, then the title of the audio con and follow the links from there.

You can now subscribe to the CMS ICD-10 e-mail updates

LeadingAge Educational Material 

There are several basic steps that CMS is recommending in preparation for ICD-10 and Version 5010:  

CMS Announcements

  • Aug. 24, 2012: HHS announces final rule on ICD-10 delay.

  • April 9, 2012: HHS delays compliance date for ICD-10 from Oct. 1, 2013, to Oct. 1, 2014. The full release is online, and more information about this proposed rule can be found on the proposed rule ICD-10 fact sheet.

  • Version 5010 Enforcement Discretion Period: According to a March 15, 2012, announcement, the Centers for Medicare and Medicaid Services (CMS) Office of E-Health Standards and Services (OESS) will not initiate enforcement action with respect to any HIPAA covered entity non-compliant with Version 5010 standards until after June 30, 2012. The compliance date for implementation of these updated standards remains Jan. 1, 2012. For more information, you can view the enforcement FAQs.

  • Feb 16, 2012: Health and Human Services (HHS) Sec. Kathleen G. Sebelius announced that HHS will initiate a process to postpone the date by which certain health care entities have to comply with International Classification of Diseases, 10th Edition diagnosis and procedure codes (ICD-10).  All HIPAA covered entities, including SNFs and HHAs, would be included in any delay  - the term “certain health care entities” is just a reference used from the original HIPAA regulatory language.

CMS Educational Conference Calls

CMS ICD-10 and Version 5010 Educational Materials

For more information on ICD-10 and Version 5010, visit CMS.


comments powered by Disqus