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
- Presentations from AAPC and CMS on ICD-10 and Version 5010. A transcript and audio of the presentations given during the webinar.
- Q&As specific to the Wed Mar 30 provider testing and readiness national provider teleconference.
- CMS ICD-10 Conversion Activities National Provider Teleconference, May 18, 2010, Slide Presentation
- Version 5010 Test Education Week, April 4-8, 2011
- CMS on ICD-10 Implementation Strategies and Planning – Nov. 17, 2011
The ICD-9-CM and ICD-10 Cooperating Parties – CMS, the American Hospital Association (AHA), the American Health Information Management Association (AHIMA), and the Centers for Disease Control and Prevention (CDC) – discuss ICD-10 implementation strategies and planning, and the CMS Provider Billing Group discuss the Medicare FFS claims processing guidance issued in August 2011. - CMS on ICD-10 Implementation Strategies for Physicians – Aug. 3, 2011
CMS subject matter experts discuss how physician offices can prepare for the change to ICD-10 for medical diagnosis and inpatient procedure coding and provide updates on national ICD-10 implementation issues affecting all providers. - CMS on ICD-10 Conversion Activities – May 18, 2011
CMS subject matter experts discuss the ICD-10 conversion process currently taking place within CMS, including a case study from the Coverage and Analysis Group on their transition to ICD-10 for the lab national coverage determinations (NCD).
CMS ICD-10 and Version 5010 Educational Materials
- Version 5010, D.0 and 3.0 Basics, a fact sheet providing an overview of Version 5010, D.0, and 3.0.
- FAQS: Versions 5010 and D.0 Basics, which lists many frequently asked questions about the Version 5010 upgrade.
- Version 5010 Testing Readiness Fact Sheet, explaining the Version 5010 upgrade and necessary Phase I Internal and Phase II External testing.
- Version 5010: Ensuring a Smooth Transition Fact Sheet, which provides steps to assist your upgrade to Version 5010.
- Version 5010: Testing Readiness, What You Need to Know
- The ICD-10 Transition: Focus on Non-Covered Entities
- ICD-10 resources available on the CMS website: Timeline Widget (for large and small providers, payers, and vendors) to help you identify and take action on the benchmarks you will need to meet to ensure smooth transition to Version 5010 and ICD-10. On the website, you will see:
- Interactive timeline widget that you can download to your desktop or mobile device.
- Printer-friendly versions of the timelines.
- ICD-10 FAQs
- CMS is also finalizing implementation handbooks later this month. Once available, we will distribute to LeadingAge members.
- Transmittal 95: The CR is to provide guidance on reporting, claims submissions and date span requirements for ICD-10 effective Oct. 1, 2013.
- CMS Announces National Version 5010 Testing Week
- CMS Calendar of Educational and Outreach Events
- Version 5010 Basics
- CMS Implementation Announcements and Reminders
- ICD-10 Overview
- MLN Matters ICD-10 Article, SE1019: Article explains the differences between ICD-9 and ICD-10, the ICD-10-CM (diagnoses codes often used in nursing homes and home health agencies) code use and structure, help with converting codes, and what providers need to do now to comply with ICD-10 implementation.
- ICD-10 Quick Reference Guide: This CMS publication addresses similarities and differences between ICD-9 and ICD-10-CM, and new features and additional changes with the new ICD-10.
- CMS Sponsored Teleconferences on ICD-10 and Version 5010: Check back soon for registration information on two upcoming ICD-10 teleconferences scheduled for May 18 and August 3.
- HIPPA Version 5010 Implementation Deadlines
- ICD 10 Myths and Facts
- The ICD-10 Transition: An Introduction
- ICD-10 Basics for Medical Practices
- Talking to Your Vendors About ICD-10 and Version 5010: Tips for Medical Practices
- Version 5010 Basics
For more information on ICD-10 and Version 5010, visit CMS.