Electronic Transactions Standards: 5010 and ICD-10
On January 16, 2009, HHS announced the final rules for 5010 and ICD-10 intended to improve patient care quality, enhance claim processing, improve reporting and promote interoperability. On March 5, 2009, the Obama Administration released their decision to proceed with both final rules on ICD-10 and the Electronic Transaction Standards without changes to the effective dates.
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Compliance dates include January 1, 2012 for the Transaction Code Sets of Version 5010, Version D.0 and Version 3.0 with small health plans having until January 2013 for Version 3.0 compliance. This provides lead time for industry compliance with the October 1, 2013 requirement for ICD-10 code sets used to report healthcare diagnoses and procedures. HIMSS commends HHS on the release of these final rules. HIMSS participated in the public comment process responding to the two proposed rules. HIMSS comments to CMS in October 2008 suggested additional time was needed for resource training and testing between trading partners to ensure successful interoperability. HIMSS supports the government's efforts with these two rules and provides support and resources to help ensure industry compliance with these two rules.
5010: The "5010" transactions and "D.0" pharmacy standards address electronic claims, electronic eligibility verification, electronic claim status, electronic referral certification and authorization, electronic remittance and more. Version D.0 of the pharmacy standards facilitate both coordination-of-benefits claims processing and Medicare Part D claims processing. Medicare systems are expected to be ready to handle the new 5010 standards by Jan. 1, 2011. Medicare will continue to conduct the current 4010A1 standard and the new 5010/D.0 standards from Jan. 1, 2011, until Jan. 1, 2012. This should allow those ready to use the new standards to begin on Jan. 1, 2011, while providing an additional year for other providers to be ready.
Industry Collaborations: AAHAM, ASC X12, CAQH/COREResources
HIMSS ICD-10 Cost Prediction Modeling tool assists users in predicting the financial impact of transitioning to ICD-10. Developed in Excel, the tool explores the costs incurred in transitioning to ICD-10, the effect ICD-10 will have on future revenue and steps that can be taken to mitigate the costs and risks of moving to ICD-10. The tool helps users understand the impact of ICD-10 in four key areas: coding, revenue cycle, project management and information technology.
ICD-10 Task Force Budget Worksheet is a budget worksheet that supports the educational presentation that was given to the HIMSS ICD-10 Task Force during their November 19th meeting by HIMSS ICD-10 Task Force Chair, Tori Sullivan, MHA, RHIA, PMP, Capgemini.
HIMSS ICD-10 Task Force AHIMA Training outlines the six guiding principles for ICD10 Training: 1. Customize training to the role 2. Assess competence and tailor training to the individual 3. Provide training at the right time 4. Leverage the full implementation time span 5. Employ varied training methodologies
6. Leverage training organization-wide.
HIMSS ICD-10 Task Force CIGNA Discussion is a presentation from CIGNA Healthcare providing information on payor ICD10 project timelines and status as well as key impacts on payors that also impact providers.
HIMSS ICD-10 Task Force Contracting is a Presentation from Hunter, Maclean, Exley & Dunn, P.C. discussing contract clauses and provisions that may be necessary with ICD-10 updates.
WEDI ICD-10 Activities Overview is an ntroduction to WEDI; Detailed steps in the ICD-10 Implementation process inclusive of best practices for vendors, plans, and providers.
Read the overview of the semi-annual HIMSS 5010/ICD-10 Readiness Survey, conducted in December 2010.
CMS Timelines for ICD-10 and Version 5010 Compliance Timelines is a useful list of key deadlines for providers, payers, vendors, etc., to ensure compliance.ICD-10 Lessons Learned from Canada is an educational presentation that was given to the HIMSS ICD-10 Task Force during their December 17th meeting by Chris Wierz, Courtyard, and Kerry Johnson, CHIM Information Consulting.
Provider Survey on 5010/ICD-10 Progress is an educational presentation that was given to the HIMSS ICD-10 Task Force during their December 17th meeting by HIMSS Financial Systems Steering Committee Chair, Joe Miller, Director, AmeriHealth Mercy.
The HIMSS Online Buyer's Guide is a comprehensive searchable database connecting you with a wide range of healthcare IT products and services. As a provider, you need to make informed and strategic purchasing decisions as you build your healthcare IT infrastructure. And today, with unprecedented financial incentives available via the American Recovery and Reinvestment Act, you need to act now to identify, evaluate and select those top vendors who can best help you to meet your technology objectives.
Budget Planning for 5010/ICD-10 Projects is an educational presentation that was given to the HIMSS ICD-10 Task Force during their November 19th meeting by HIMSS ICD-10 Task Force Chair, Tori Sullivan, MHA, RHIA, PMP, Capgemini.
5010/D.0 Tools and Resource Guide is a fact sheet developed by the HIMSS 2010 ICD-10 Task Force. This fact sheet will help you prepare your organizations for transitioning from HIPAA Transaction Code 4010 to Version 5010 and D.0.
5010/D.0 & ICD-10 Interrelationships is a fact sheet developed by the HIMSS 2010 ICD-10 Task Force. This fact sheet will help you to understand the connections between the 5010 and ICD-10 regulations.
ICD-10's Impact on Coding Operations: Practical Insights for Senior Leaders is an educational presentation that was given to the HIMSS ICD-10 Task Force during their October 15th meeting by Dwan Thomas Flowers, MBA, RHIA, CCS, Special Projects Manager, Revenue Cycle Services, Mayo Clinic.
ICD-10-CM/PCS Tools and Resource Guide: Prepare your Organizations for transitioning from ICD-9-CM to ICD-10-CM and ICD-10-PCS is a fact sheet developed by the HIMSS 2009 ICD-10 Task Force. This fact sheet addresses the current implementation timelines and provides valuable industry resources regarding this important transition.
HIPAA 5010 Overview is an educational presentation that was given to the HIMSS ICD-10 Task Force during their September 17th meeting by Linda J. Corley, BS, MBA, CPC
Corporate Compliance Officer, Perot Systems Revenue Cycle Solutions.
HIPAA Transaction Code Set 5010: Implications and Opportunities is a white paper developed by the HIMSS Financial Systems Steering Committee. This paper facilitates understanding of the challenges and advantages of 5010 implementation. It provides a summary of this code set, outlines key implications and anticipated opportunities, and provides practical guidelines for the implementation of 5010.
HIPAA 5010: A Second Chance for the Industry to Implement Transaction Standards to Reduce Costs and Increase Efficiency The implementation of the 5010 standard is an excellent opportunity for the industry to reduce the rising health care costs that are creating financial pressures for patients, employers, providers, payers and many others. Stakeholders representing their perspective have a role in leading the industry from the 4010 to the 5010 standard.
ICD-10 Conversion ~ Planning Ahead explores what one organization's Information Technology Department is doing in preparation for the ICD-10 transition. This transition will be a significant industry effort by all stakeholders and it is not too early to start planning! This presentation is a collaboration with the 2008 – 2009 HIMSS Financial Systems Steering Committee.
HIMSS ICD 10 Resource Listing is a tool to locate key information resources on ICD 10. The listing provides a quick reference of resources available to the industry including ICD 10 basics, implementation and frequently asked questions. This tool was developed by the 2007-2008 HIMSS Financial Systems Steering Committee.
The CMS Corner
5010 & D.0
Check out the CMS 5010 web page for the latest information on Electronic Billing and EDI Transactions — 5010 & D.0
ICD-10
Check out the CMS ICD-10 web page for the latest information on conversion to ICD-10 Procedure Coding System (PCS) and Clinical Modifications (CM).
5010 and ICD-10 Rules
You can now view a fact sheet at the Centers for Medicare & Medicaid Services Web site describing both rules . Both regulations may be in the Federal Registry.
Additional Resources
CMS provides additional resources and information on 5010 and ICD-10. Visit their Web site for more details.
