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CMS Proposed Rule Would Move ICD-10 Compliance Date to 2014

Monday, April 16, 2012
CMS Proposed Rule Delays ICD-10 Compliance by One Year

Key Development: The proposal moves the ICD-10 compliance date from Oct. 1, 2013, to Oct. 1, 2014.

Other Development: The proposed rule also includes a requirement for unique health plan identifiers.

Next Steps: Comments on the proposed rule are due May 17.

The Centers for Medicare & Medicaid Services April 9 announced a proposed rule that would delay the compliance date for the International Classification of Diseases, 10th Revision (ICD-10) code set from Oct. 1, 2013, until Oct. 1, 2014.

The proposed rule (CMS-0040-P) also included a requirement for health plans to adopt a unique health plan identifier for all Health Insurance Portability and Accountability Act (HIPAA) transactions. Health plans currently use several different identifiers that vary in format.

The ICD-10 delay was influenced in part by concerns from providers over their ability to meet the 2013 compliance date, according to the proposed rule, which will be published in the April 17 Federal Register. Comments will be due May 17.

The ICD-10 delay originally was announced Feb. 16 by Department of Health and Human Services Secretary Kathleen Sebelius, who said the department was committed to working with the provider community to come up with a new compliance date (see previous article).

In a release, CMS said that ICD-10 “will include new procedures and diagnoses and improve the quality of information available for quality improvement and payment purposes.”

Provides' Compliance Concerns
“Since publication of the ICD-10 and Modifications final rules, a number of other statutory initiatives were enacted, requiring health care provider compliance and reporting. Providers are concerned about their ability to expend limited resources to implement and participate in … initiatives that all have similar compliance timeframes,” according to the proposed rule.

In addition to ICD-10, providers are working to implement electronic health record (EHR) technology to comply with the Medicare and Medicaid EHR Incentive Program requirements, as well as comply with electronic prescribing requirements under the Medicare eRx Incentive Program.

CMS considered extending the delay until October 2015, but determined it would place too much financial burden on organizations that were expecting to be ICD-10-compliant by the original 2013 date. CMS also said it was concerned that a two-year delay would lead to organizations abandoning ICD-10 implementation efforts.

The ICD-10 code set is intended to be used for classifying health care diagnoses and procedures and will replace an earlier code set, ICD-9. All transactions subject to HIPAA rules, including outpatient and inpatient claims, will be required to use ICD-10 codes once the compliance date is reached.

The proposed rule also said problems with Version 5010 implementation factored into the ICD-10 delay.

Version 5010 is an infrastructure system for electronic claims and related transactions, and successful implementation is a prerequisite for using ICD-10.

“As implementation of ICD-10 is predicated on the successful transition of industry to Version 5010, we are concerned that the delays encountered in Version 5010 have affected ICD-10 planning and transition timelines,” the proposed rule said.

All HIPAA-covered entities were required to be in compliance with Version 5010 by Jan. 1, but CMS has twice delayed the enforcement date, most recently on March 15, when it said that it would not initiate any enforcement actions against noncompliant entities until June 30(see previous article).

Health Plan Identifiers
The proposed rule also would implement provisions contained in Section 1104 of the Patient Protection and Affordable Care Act requiring health plans to adopt a unique identifier for all HIPAA-covered transactions.

HIPAA-covered health plans face a number of problems due to a lack of a unique identifier, the proposed rule said, including:


  • improper routing of transactions;

  • rejected transactions caused by insurance identification errors;

  • issues with determining patient eligibility; and

  • errors arising from health plan identification errors made during claims processing.


The adoption of a unique health plan identifier “will allow for a higher level of automation for health care provider offices, particularly for provider processing of billing and insurance related tasks, eligibility responses from the health plans, and remittance advice that describes health care claim payments,” the proposed rule said.

CMS expects to publish a final rule on the unique health plan identifiers on Oct. 1, and the compliance date for all covered entities, except small health plans, would be Oct. 1, 2014. Small plans would have until Oct. 1, 2015, to comply with the requirement.

Provider Identifiers
The proposed rule also included a requirement to expand the use of national provider identifiers (NPIs).

Currently, non-HIPAA covered entities are not required to have an NPI, which has led to problems for covered entities that need to disclose a noncovered provider in their transactions.

The proposed rule would require certain providers not covered by HIPAA who are also prescribers to obtain an NPI, and would require them to disclose the NPI to any entity that needs it for the completion of a standard health care transaction.

CMS expects to publish a final rule on this subject on Oct. 1, with a compliance date set for April 7, 2013.


The CMS proposed rule is available at /uploadedFiles/Content/News/Legal_and_Business/Bloomberg_Law/Legal_Reports/UniqueHealthPlanID(1).pdf

A CMS fact sheet on the ICD-10 delay is available at /uploadedFiles/Content/News/Legal_and_Business/Bloomberg_Law/Legal_Reports/ACO-fact-sheet-april-10(1).pdf

A CMS fact sheet on the proposed rule's establishment of unique health plan identifiers is available at /uploadedFiles/Content/News/Legal_and_Business/Bloomberg_Law/Legal_Reports/UniqueHealthPlanID(1).pdf

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