Final Administrative Simplification Rules for Plan ID, NPI Addition, and ICD-10 Code Set Compliance Delay Published in Federal Register

September 5, 2012.  Today, the Federal Register published 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 [NPI] 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.  We provided the detailed “Executive Summary” in our August 24, 2012, posting, based on the preview posting at the Federal Register’s Electronic Public Inspection Desk.  Below we provide the shorter publication “Summary” [p.54664]:

“This final rule adopts the standard for a national unique health plan identifier (HPID) and establishes requirements for the implementation of the HPID.  In addition,it adopts a data element that will serve as an other entity identifier (OEID), or an identifier for entities that are not health plans, health care providers, or individuals, but that need to be identified in standard transactions.  This final rule also specifies 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 a National Provider Identifier (NPI).  Lastly, this final rule changes 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.”

This Final Rule as official policy is effective on November 5, 2012.  Health plans other than small health plans must obtain an HPID by November 5, 2014.  Small health plans have an additional year to comply, on November 5, 2015.  Covered entities must use the HPID in standard transactions on or after November 7, 2016.  With regard to the NPI, an organization covered health care provider must comply by May 6, 2013, with the implementation specifications in 45 CFR 162.410(b):

“An organization covered health care provider that has as a member, employs, or contracts with, an individual health care provider who is not a covered entity and is a prescriber, must require such health care provider to–

(1) Obtain an NPI form the National Plan and Provider Enumeration System (NPPES); and

(2) To the extent the prescriber write a prescription while acting within the scope of the prescriber’s relationship with the organization, disclose the NPI upon request to any entity that needs it to identify the prescriber in a standard transaction.” [p. 54719]

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