The U.S. Department of Health and Human Services (HHS) released two final rules Thursday: one for the adoption of the next generation of diagnosis and procedure codes, ICD-10, and another that updates standards for electronic healthcare and pharmacy transactions.
The first final rule replaces the ICD-9-CM code sets with expanded ICD-10 code sets, with a compliance date of Oct. 1, 2013, providing nearly five years from the date of publication to implement the new code sets. The 2013 compliance date also corresponds with the effective date for annual changes to Medicare payment systems.
The second final rule adopts updates to the X12 standard, Version 5010, which is an updated version of the National Council for Prescription Drug Programs (NCPDP) standard, Version D.0, for electronic pharmacy-related transactions, and a standard for Medicaid pharmacy subrogation transactions. The transaction standards final rule sets compliance dates of Jan. 1, 2012, for Version 5010, Version D.0 and Version 3.0 (except for small health plans that have an additional year and must be compliant with Version 3.0 on Jan. 1, 2013). These dates provide covered entities nearly three years from publication of the final rule to achieve compliance.
The original compliance date was proposed as Oct. 1, 2011. The American Medical Association (AMA) and its partner organizations advocated a longer transition timeline to ensure it would be successful, proposing three years for the 5010 implementation and no sooner than five years after that for ICD-10 adoption.
“A number of comments asked for a delay in the compliance dates for both ICD-10 and Version 5010, citing implementation costs, the need to train health care personnel, and to assure ample time for testing between trading partners. HHS recognized these concerns and the final rules delay the implementation dates between the proposed and final rules by 21 months for the 5010 standards, and by 24 months for the ICD-10 codes. We look forward to working with all parties to ensure a smooth conversion to the updated transaction standards and ICD-10 code set,” said Kerry Weems, acting administrator of the Centers for Medicare & Medicaid Services (CMS).
The American Health Information Management Association (AHIMA) said that it was “sorry” to see the compliance deadline extended.
“This further extension means more years without the data needed to make intelligent data-driven decisions related to all aspects of healthcare. None-the-less, this extra time gives the industry no excuse for an adequate implementation and compliance. The extra time should be used wisely and the industry needs to start now and not wait,” according to AHIMA.