CMS Confirms 5010 and ICD-10 Rules’ Effective Dates

In notification to the U.S. House and Senate on Thursday, March 5, 2009, Don Johnson, Acting Director, Office of Legislation of the Centers for Medicare & Medicaid Services (CMS), notified the Congress that “[i]n accordance with the White House Chief of Staff’s memorandum of January 20, 2009 entitled ‘Regulatory Review,’ a determination has been made that the effective date will not be extended and the comment period will not be reopened for either of these rules.” The effective date for each of the rules is March 17, 2009. The memorandum CMS sent to Congress follows. Beginning next Monday, March 9, will have a posting daily through March 17, 2009,…


Testing 5010 with Trading Partners

When the 5010 final rule becomes effective on March 17, 2009, health plans can begin testing with willing trading partners the 5010 standard transactions alongside the current 4010/4010A1 transactions standards. The improvements in the 5010 version 835 Health Care Payment and Remittance Advice transaction (835) for all claim types may benefit both health plans and healthcare providers. “Correct implementation of the X12 835 will reduce phone calls to health plans, reduce appeals due to incomplete information, eliminate unnecessary customer support, and reduce the cost of sending and processing paper remittance advices” [74 Federal Register 3298]. Remember, use of the 5010 version 835 transaction standard “in advance of the mandatory compliance…


Companion Guides

HHS notes that “the improvements to Version 5010 should minimize dependence on companion guides… and “strongly discourage[s] health plans from having companion guides unless they are focused significantly on the basics for continuity, trading partner arrangements, and use of situational data elements…. [I]f companion guides contradict the implementation guides, the transaction will not be compliant.” [74 FR 3307-3308]

Dual Use of Existing Standards

Note that HHS permits the dual use of existing standards (4010/4010A1 and 5.1) and the new standards (5010 and D.0) from the March 17, 2009, effective date until the January 1, 2012 compliance date, to facilitate testing and subject to trading partner agreement.

5010 Testing

HHS recommends that the first of two testing levels of Version 5010 and D.0 begin now for all covered entities to achieve compliance beginning January 1, 2012. HHS expects no contingency period beyond that date and may impose civil penalties for non-compliance.