2/16/2012       HHS Announces Intent to Delay ICD-10 Compliance Date

 As part of President Obama’s commitment to reducing regulatory burden, Health and Human Services Secretary Kathleen G. Sebelius today 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).

 The final rule adopting ICD-10 as a standard was published in January 2009 and set a compliance date of October 1, 2013 – a delay of two years from the compliance date initially specified in the 2008 proposed rule. HHS will announce a new compliance date moving forward.

 “ICD-10 codes are important to many positive improvements in our health care system,” said HHS Secretary Kathleen Sebelius. “We have heard from many in the provider community who have concerns about the administrative burdens they face in the years ahead. We are committing to work with the provider community to reexamine the pace at which HHS and the nation implement these important improvements to our health care system.”

 ICD-10 codes provide more robust and specific data that will help improve patient care and enable the exchange of our health care data with that of the rest of the world that has long been using ICD-10. Entities covered under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) will be required to use the ICD-10 diagnostic and procedure codes.

2/17/2012   Extension of Therapy Cap Automatic Exceptions Process

 Today, Congress approved the Payroll Tax Cut Conference Agreement, which includes an extension of the Therapy Cap exceptions process through December 31, 2012.  The Senate approved the measure by a 60-36 vote, within minutes after the House approved it by a 293-132 vote.  President Obama is expected to sign into law upon returning to Washington.

 Thank you to all NASL members for writing letters and making Hill visits to their Members of Congress in support of extending the Therapy Caps exceptions process!

Get Ready for ICD-10!

On October 1, 2013, a major transformation of key data elements involved in health care delivery will occur. Across the country, we will transition from the decades-old Ninth Edition of the International Classification of Diseases (ICD-9) set of diagnosis and inpatient procedure codes to the far more contemporary, vastly larger, and much more detailed Tenth Edition of those code sets—or ICD-10—used by most developed countries throughout the world.

This transition will have a major impact on anyone who uses health care information that contains a diagnosis and/or in-patient procedure code, including:

• Hospitals
• Health care practitioners and institutions
• Health insurers and other third-party payers
• Electronic-transaction clearinghouses
• Hardware and software manufacturers and vendors
• Billing and practice-management service providers
• Health care administrative and oversight agencies
• Public and private health care research institutions

Making the transition to ICD-10 is not optional

All "covered entities"—as defined by the Health Insurance Portability and Accountability Act of 1996 (HIPAA)—are required to adopt ICD-10 codes for use in all HIPAA transactions with dates of service on or after the October 1, 2013 compliance date. For HIPAA inpatient claims, ICD-10 diagnosis and procedure codes are required for all inpatient stays with discharge dates on or after October 1, 2013.

What to do NOW

To process ICD-10 claims or other transactions, providers, payers and vendors must first implement the "Version 5010" electronic health care transaction standards mandated by HIPAA. The existing HIPAA "Version 4010/4010A1" transaction standards do not support the use of the ICD-10 codes. This requires install of Version 5010 in practice management or other billing systems. See CMS website at http://www.cms.hhs.gov/ICD10 and click on "Version 5010" on the left side of the page.

Key Changes with ICD-10-CM:

• Longer codes 3-7 characters compared to 3-5 characters in ICD-9-CM
• ICD-10-CM: Digit-1 alpha; Digit -2 numeric; Digit – 3 alpha or numeric
• Allows for flexibility for the addition of codes in the future unlike ICD-9-CM
• Includes very specific code detail (comorbidities, manifestations, etiology/causation, detailed anatomical location, sequelae, degree of functional impairment, biologic and chemical agents, phase/stage, lymph node involvement, lateralization and localization, procedure or implant related, age-related or joint involvement)

ONR will work with our software vendor to ensure that our billing system will be ready and able to accommodate the new coding methodology.