HHS proposes new ICD-10 deadline, unique health plan identifier

The U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius has announced a proposed rule that would establish a unique health plan identifier under HIPAA. The proposed rule also delays required compliance by one year—from Oct. 1, 2013, to Oct. 1, 2014—for new codes used to classify diseases and health problems.

The proposed rule would implement several administrative simplification provisions of the Patient Protection and Affordable Care Act (PPACA), the agency said.

Currently, when health plans and entities like third-party administrators bill providers, they are identified using a wide range of different identifiers that do not have a standard length or format. As a result, according to the HHS, healthcare providers run into a number of time-consuming problems, such as misrouting of transactions, rejection of transactions due to insurance identification errors and difficulty determining patient eligibility.

The rule will seek to simplify the administrative process for providers by proposing that health plans have a unique identifier of a standard length and format to facilitate routine use in computer systems. This could allow provider offices to automate and simplify their processes, particularly when processing bills and other transactions.

As for the ICD-10 delay, HHS said that these codes will include new procedures and diagnoses and improve the quality of information available for quality improvement and payment purposes. Many provider groups have expressed serious concerns about their ability to meet the Oct. 1, 2013, compliance date. The proposed change in the compliance date for ICD-10 would give providers and other covered entities more time to prepare and fully test their systems to ensure a smooth and coordinated transition to these new code sets.

"I’m relieved that a year is the maximum they're going to delay implementation," Dana Moore, CIO for Centura Health in Englewood, Co., said in an interview. For those who have more remediation work to do, the delay gives them time to get that work done. Moore suggested that facilities use the extra time for additional testing. He also recommended that those responsible for ICD-10 implementation at their hospital continue with their plans as though the implementation date is still in 2013 because "you will have issues you don't expect."

The proposed rule is the third in a series of administrative simplification rules in PPACA HHS released July 1, 2011 and Jan. 2, 2012. HHS plans to announce more in coming months.

Comments on the proposed rule are due 30 days after publication in the Federal Register.