November 17, 2011, 5:48 PM — 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.