News and Updates

CMS Proposes New HIPAA Claims Standards and ICD Coding

(August 26, 2008)

Comments Due to CMS by October 21, 2008

On August 22, two proposed rules from the Centers for Medicare & Medicaid Services (CMS) were published in the Federal Register.

Proposed rule CMS-0009-P would adopt the ASC X12N version 5010 set of standards for electronic claims, remittance advices, and other transactions standardized under the Healthcare Insurance Portability and Accountability Act (HIPAA). These standards were developed in the time period of 2004 and 2005, and NHIA’s Vice President of Health Information Policy Bruce E Rodman represented the interests of the infusion provider community within the X12N group during their development. CMS-0009-P also proposes adoption of the NCPDP Telecommunication Standard vD.Ø and Batch Standard v1.2 for retail pharmacy claims. Health care providers, plans and clearinghouses would be required to upgrade to these versions no later than April 1, 2010, replacing the existing older versions used today per current regulations.

Proposed rule CMS-0013-P would adopt the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) for diagnosis coding, and the International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS) for inpatient hospital procedure coding. Health care providers, plans and clearinghouses would be required to use ICD-10 coding no later than October 1, 2011, replacing the current use of ICD-9 coding in use today per current regulations.

NHIA will consider comments to submit on behalf of the home infusion community. If you have comments that you think NHIA should include, contact Rodman at Bruce.Rodman@sbcglobal.net or 847-362-2017.

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NHIA members: find out about all recent developments in health care electronic data interchange that are important to the infusion community in the Home Infusion EDI Coalition (HIEC) News Archives.