ICD-10, Health Plan Identifiers (HPIDs), and CMS

Medicare (CMS/HHS) Bulletin:
On September 5, 2012, HHS published a final rule delaying the ICD-10 compliance date to October 1, 2014 (and now 2015). In that same rule, HHS adopted a standard for a unique health plan identifier (HPID) requiring health plans to obtain an HPID by November 5, 2012. Small health plans had until November 5, 2012, to comply.

Confused about all the new rules? Well, here are more (lots of acronyms so we decoded them for you). In line with the anticipated changes to the ICD-10 Coding System, other related imperatives have been officially announced, complete with their compliance dates. All of the new rules are important for medical providers and their billing, coding, and practice managers.

HPID (Health Plan Identifier)
Currently, health plans and other entities that perform health plan functions, such as third party administrators and clearinghouses, are identified in Health Insurance Portability and Affordability Act of 1996 (HIPAA) standard transactions with multiple identifiers that differ in length and format. Covered health care providers are frustrated by various problems associated with the lack of a standard identifier, such as: improper routing of transactions; rejected transactions due to insurance identification errors; difficulty in determining patient eligibility; and challenges resulting from errors in identifying the correct health plan during claims processing.

The adoption of the HPID and the OEID (Other Entity Identifier) will increase standardization within HIPAA standard transactions and provide a platform for other regulatory and industry initiatives. Their adoption 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 health plans, and remittance advice that describes health care claim payments.

HIPAA Testing Pilot
As part of ongoing CMS efforts to provide resources for implementing HIPAA standards, operating rules, and code sets, National Government Services will conduct an “end-to-end testing” pilot. End-to-end testing refers to testing processes from beginning to end, which for HIPAA involves testing claims and other transactions within and across health care organizations, including providers, payers, clearinghouses, and billing services. The goal is to develop tools, benchmarks, and best practices for testing and implementing HIPAA Administrative Simplification requirements. As a key part of HIPAA, ICD-10 will be a focus of the testing.

Watch www.med-certification.com and ICD10-training.com for future ICD-10 updates and pilot results from the HHS folks. If you are already in the billing-coding field, follow the bulletins and do the webinars. If you are a wannabee, you can see the complexities in health care business and regulatory matters, and the automation process.