CMS Issues Final Administrative Simplification Final Rules Regarding Identifiers and ICD-10 Code Set Compliance Delay

August 24, 2012. Today, the Office of Management and Budget (OMB) completed review and sent to the Federal Register for publication on September 5, 2012, the Centers for Medicare & Medicaid Services (CMS) Final Rule: Administrative Simplification: Adoption of a Standard for a Unique Health Plan Identifier; Addition to the National Provider Identifier Requirements; and a Change to the Compliance Date for the International Classification of Diseases, 10th Edition (ICD-10-CM and ICD-10-PCS) Medical Data Code Sets. The effective date of the Rule is November 5, 2012. Prior to publication on September 5, the Final Rule may be examined at or downloaded from the Office of the Federal Register’s Electronic Public Inspection Desk.

EFT and RA Transaction Operating Rules IFC Published in Federal Register August 10

August 10, 2012. Today, the Interim Final Rule with comment period (IFC): Administrative Simplification: Adoption of Operating Rules for Electronic Funds Transfers (EFT) and Remittance Advice Transactions, was published in the Federal Register. The effective date of the IFC is the date of publication, August 10, 2012. Comments on the IFC may be submitted to the Department of Health and Human Services (HHS) on or before October 9, 2012, with submission instructions included on page 48008 of the IFC. Covered entities must be in compliance with the EFT & ERA Operating Rule Set by January 1, 2014.

CMS Initiates 90-Day Enforcement Discretion for 5010 Compliance

The Center for Medicare & Medicaid Services (CMS) Office of E-Health Standards and Services (OESS) is responsible for enforcement of compliance with electronic transaction standards. January 1, 2012, is the date for covered entities to achieve compliance with ASC X12 Version 5010, NCPDP Telecom D.0, and NCPDP Medicaid Subrogation 3.0 transaction standards. CMS announced on November 17, 2011, that “[w]hile enforcement action will not be taken [from January 1-March 31, 2012], OESS will continue to accept complaints associated with compliance with Version 5010, NCPDP D.0 and NCPDP 3.0 transaction standards during the 90-day period…. If requested by OESS, covered entities that are the subject of complaints (known as ‘filed-against entities’) must produce evidence of either compliance or a good faith effort to become compliant with the new HIPAA [version] standards during the 90-day period.” [emphasis added]

Exploring HIPAA and HITECH Act Definitions: Part 5

From now through November, HIPAA.com is providing a run through of HIPAA transaction & code set, privacy, and security definitions, along with relevant HITECH Act definitions pertaining to breach notification and securing of protected health information. These definitions are key to understanding the referenced HIPAA and HITECH Act enabling regulations that are effective now and that will require compliance by covered entities and business associates now or in the months ahead, as indicated in HIPAA.com’s timeline.

Exploring HIPAA and HITECH Act Definitions: Part 4

From now through November, HIPAA.com is providing a run through of HIPAA transaction & code set, privacy, and security definitions, along with relevant HITECH Act definitions pertaining to breach notification and securing of protected health information. These definitions are key to understanding the referenced HIPAA and HITECH Act enabling regulations that are effective now and that will require compliance by covered entities and business associates now or in the months ahead, as indicated in HIPAA.com’s timeline.

Exploring HIPAA and HITECH Act Definitions: Part 3

From now through November, HIPAA.com is providing a run through of HIPAA transaction & code set, privacy, and security definitions, along with relevant HITECH Act definitions pertaining to breach notification and securing of protected health information. We begin the first series of postings with definitions from “Health Insurance Reform; Modifications to the Health Insurance Portability and Accountability Act (HIPAA); Final Rules,” Federal Register, January 16, 2009. 45 CFR 162, Administrative Requirements: 162.103, Definitions.

Exploring HIPAA and HITECH Act Definitions: Part 2

From now through November, HIPAA.com is providing a run through of HIPAA transaction & code set, privacy, and security definitions, along with relevant HITECH Act definitions pertaining to breach notification and securing of protected health information. We begin the first series of postings with definitions from “Health Insurance Reform; Modifications to the Health Insurance Portability and Accountability Act (HIPAA); Final Rules,” Federal Register, January 16, 2009. 45 CFR 162, Administrative Requirements: 162.103, Definitions.

Exploring HIPAA and HITECH Act Definitions: Part 1

From now through November, HIPAA.com is providing a run through of HIPAA transaction & code set, privacy, and security definitions, along with relevant HITECH Act definitions pertaining to breach notification and securing of protected health information. We begin the first series of postings with definitions from “Health Insurance Reform; Modifications to the Health Insurance Portability and Accountability Act (HIPAA); Final Rules,” Federal Register, January 16, 2009. 45 CFR 162, Administrative Requirements: 162.103, Definitions.

Direct Data Entry-No Change in the 5010 Final Rule

In the August 17, 2000 Final Rule for Standards for Electronic Transactions, direct data entry was defined as “direct entry of data (for example, using dumb terminals or web browsers) that is immediately transmitted into a health plan’s computer.” [65 Federal Register 50367] An exception for direct data entry was articulated in the August 17, 2000, Final Rule: A health care provider electing to use direct data entry offered by a health plan to conduct a transaction for which a standard has been adopted under this part must use the applicable data content and data condition requirements of the standard when conducting the transaction. The health care provider is not required to use the format requirements of the standard.” [65 Federal Register 50369]

5010/D.0 Effective Date Tuesday, March 17, 2009; Compliance Date January 1, 2012

The version modification to the HIPAA Administrative Simplification transaction standards becomes effective next Tuesday, March 17, 2009. Here are several critical things to know, drawn directly from the final rule published in the Federal Register on January 16, 2009. The final rule is available for download on the HIPAA.com site.