CMS issues compliancy reminder for HIPAA orgs in January 2011

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The Centers for Medicare & Medicaid Services (CMS) has issued a reminder to healthcare providers, health plans, clearinghouses and vendors about the approaching January 2011 compliance date for testing transaction standards.

The first compliance milestone for transition to the Accredited Standards Committee X12 Technical Reports Type 3, Version 005010 (Version 5010) electronic healthcare transaction standards is fast approaching, CMS stated. Beginning in January 2011, entities covered under 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 healthcare transactions, including claims, remittance advice, eligibility inquiries, referral authorization and other administrative transactions, will be mandatory on Jan. 1, 2012. According to CMS, 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 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,” CMS stated in the reminder. “The greatly expanded ICD-10 code sets will support quality reporting, pay-for-performance, bio-surveillance and provide a rich terminology for use of EHRs.”

Beginning January 2011, the Medicare Fee-for-Service program will be ready to test Version 5010 transaction standards with its external partners and CMS stated it anticipates 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.

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 website. All of the information is free and can be downloaded here.