One Week from Today: 5010/D.0 Final Rule Effective Date

They’re coming: the Ides of March (the 14th); NCAA Basketball Tournament Announcement (the 15th); St. Patrick’s Day (the 17th); and 5010/D.0 Final Rule Effective Date (the 17th). If you are a covered entity, Level 1 testing begins Tuesday, March 17, 2009. Here are five things you need to do to start. Conduct a Gap Analysis. What do I need to do to become compliant on January 1, 2012? That date sounds far off, but it will be here before you know it. Unlike previous transaction contingency periods for covered entities and their trading partners, HHS has indicated that there will be no tolerance for those not ready. Read the final…

READ MORE

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, HIPAA.com will have a posting daily through March 17, 2009,…

READ MORE

Is Your Covered Entity Preparing for 5010/D.0 Testing? Part 2: Level 2 Testing

On March 17, 2009, the Final Rules for Modifications to the Health Insurance Portability and Accountability Act (HIPAA) become effective. HIPAA.com has available for download the final rules for 5010/D.0 as published in the Federal Register on January 16, 2009 (pp.3295-3328). The effective date is “the date that the policies set forth in this final rule take effect, and new policies are considered to be officially adopted.” [p.3302]. All covered entities are to be in compliance with 5010/D.0 on January 1, 2012. Testing can occur “from the date of the final rule until the compliance date for Versions 5010 and D.0.” [p. 3306] The Final Rules outline two levels of…

READ MORE

Is Your Covered Entity Preparing for 5010/D.0 Testing? Part 1: Level 1 Testing

On March 17, 2009, the Final Rules for Modifications to the Health Insurance Portability and Accountability Act (HIPAA) become effective. HIPAA.com has available for download the final rules for 5010/D.0 as published in the Federal Register on January 16, 2009 (pp.3295-3328). The effective date is “the date that the policies set forth in this final rule take effect, and new policies are considered to be officially adopted.” [p.3302]. All covered entities are to be in compliance with 5010/D.0 on January 1, 2012. Testing can occur “from the date of the final rule until the compliance date for Versions 5010 and D.0.” [p. 3306] The Final Rules outline two levels of…

READ MORE

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…

READ MORE

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.

New HIPAA Standard Transaction Rules Released

On Friday, January 16, 2009, the Office of the Secretary of the Department of Health and Human Services published in the Federal Register final rules pertaining to: Health Insurance Reform; Modifications to the Health Insurance Portability and Accountability Act (HIPAA) Electronic Transaction Standards (74 Federal Register 3295-3328); and, HIPAA Administrative Simplification: Modifications to Medical Data Code Set Standards to Adopt ICD-10-CM and ICD-10-PCS (74 Federal Register 3328-3362).

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.

Final 5010 Rule

DEPARTMENT OF HEALTH AND HUMAN SERVICES 45 CFR Part 162 | [CMS–0009–F] | RIN 0938–AM50 Health Insurance Reform; Modifications to the Health Insurance Portability and Accountability Act (HIPAA) Electronic Transaction Standards AGENCY: Office of the Secretary, HHS. ACTION: Final rule. Download (Requires Acrobat Reader)