Feds back off on Jan.1 eHealth standards deadline

U.S. health officials delay enforcement until March 31, 2012

The U.S. Centers for Medicare & Medicaid said Thursday that it will delay enforcement of a deadline for healthcare providers to roll out a new version of a standard governing how medical transactions are processed.

The deadline for Version 5010 of HIPPA transaction and code set standards was scheduled to take effect Jan. 1, 2012. It has been pushed out to March 31 (download PDF), according to the agency's Office of E-Health Standards and Services (OESS).

Besides requiring more information to be transmitted between healthcare providers and payers, Version 5010 is foundational to the adoption of the new ICD-10 medical coding system standard.

The federally mandated ICD-10 coding system is designed to better track diagnoses and treatments; it affects dozens of core applications for healthcare providers and insurance payers. Medical providers and insurance payers are required to move from the current ICD-9 coding system to ICD-10 by Oct. 1, 2013. The move has been under way since 2008, but most hospitals have not yet begun the change-over.

"The ICD-10 code set format is different; there are additional fields," said Denise Buenning, director of OESS's Administrative Simplification Group. "The codes [increase] from 15,000 to 150,000, but the most important thing Version 5010 does that Version 4010 doesn't [is] it ... tells the system, 'You're getting an ICD-10 code. It's not a mistake that you're seeing extra digits or an alpha-numeric format. It's not a mistake. Accept the code.'"

Even though the old deadline won't be enforced, the OESS still wants to "encourage" all health organizations covered by HIPPA regulations to become version 5010-compliant by Jan. 1.

"This is not an extension of the compliance date of Jan. 1, 2012," Buenning said. "That date remains intact. But this enforcement discretion period gives HIPAA-covered entities time to complete testing and become compliant without being penalized under our HIPAA enforcement authority."

Currently, hospitals, clinics and private physician practices that fall under the guidelines of the Health Insurance Portability and Accountability Act (HIPAA) of 1996 use version 4010 of transaction standards, as they have for the past 30 years or so. The standard governs the way in which patient healthcare eligibility information is transmitted between healthcare providers and payers.

"It's antiquated and doesn't meet current industry needs," Buenning said.

Buenning said that each time a new government program was rolled out in the past -- for example, the Medicare prescription drug benefit program -- the 4010 version standard could not accommodate claims information requirements. That forced many organizations to use a "Band-Aid approach to make it work," she said.

"Version 5010 solves a lot of the gaps that existed and makes it one cohesive package," she said.

The 4010 communications standard allowed healthcare providers, health plans and medical information clearing houses to send and receive information back and forth by phone or fax.

The reason Version 5010 is important is because it standardizes and speeds the transmission of information, alleviating the need for an administrative assistant or nurse to pick up a phone or fax the information.

For example, a private physician might now use practice management software to send patient information to an insurance company to determine eligibility for coverage.

Under Version 4010 of the regulations, when that request is sent, a health plan is only obligated to say yes or no on eligibility. Version 5010 gives the provider a lot more information. "It says, 'Yes, this patient is eligible, they've been a participant in our plan since this date, here's their co-pay information, etc...," Buenning said. "It provides much more information.

"The upshot of all of this is that you don't have a medical assistant or a nurse on the phone trying to get this information from the plan and being put on hold. That's really the goal of all of the administrative simplification activities we undertake and all the regulations that we use to adopt standards -- to streamline and make the process of getting information for billing, eligibility and other administrative purposes much more consistent and robust," she said.

Lucas Mearian covers storage, disaster recovery and business continuity, financial services infrastructure and health care IT for Computerworld. Follow Lucas on Twitter at @lucasmearian or subscribe to Lucas's RSS feed . His e-mail address is lmearian@computerworld.com.

Copyright © 2011 IDG Communications, Inc.

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