HHS Issues HIPAA NPRM for Unique Health Plan Identifier and One Year Delay for ICD-10 Code Set Compliance

April 10, 2012.  Yesterday, the Office of the Secretary of the Department of Health and Human Services (HHS) promulgated a notice of proposed rule making (NPRM) entitled:  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 ICD-10-CM and ICD-10-PCS Medical Data Code Sets. The NPRM will be published in the Federal Register on April 17, 2012.

Here is the NPRM summary:  “This proposed rule would implement section 1104 of the Patient Protection and Affordable Care Act (hereinafter referred to as the Affordable Care Act) by establishing new requirements for administrative transactions that would improve the utility of the existing Health Insurance Portability and Accountability Act of 1996 (HIPAA) transactions and reduce administrative burden and costs.  It proposes the adoption of the standard for a national unique health plan identifier (HPID) and requirements or provisions for the implementation of the HPID.  This rule also proposes the adoption of a data element that will serve as an other entity identifier (OEID), an identifier for entities that are not health plans, health care providers, or ‘individuals,’ that need to be identified in standard transactions.  This proposed rule would also specify the circumstances under which an organization covered health care provider must require certain noncovered individual health care providers who are prescribers to obtain and disclose an NPI [National Provider Identifier].  Finally, this rule proposes to change the compliance date for the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) for diagnosis coding, including the Official ICD-10-CM Guidelines for Coding and Reporting, and the International Classification of Diseases, 10th Revision, Procedure Coding System (ICD-10-PCS ) for inpatient hospital procedure coding, including the Official ICD-10-PCS Guidelines for Coding and Reporting, from October 1, 2013 to October 1, 2014.”

Comments on the NPRM may be submitted to HHS up to 30 days from the April 17, 2012, Federal Register publication of the NPRM.  HHS has indicated that “[w]hen made final, the effective date of this regulation would be October 1, 2012.”

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