HIPAA migration from 4010 to 5010 electronic transaction set and conversion of ICD-9 code set to ICD-10 code set are two major US healthcare regulatory compliance mandates for Healthcare payers and providers. These initiatives will impact nearly every core process, system and interface across the industry and require major changes and have specific time lines for implementation.
January 1, 2012 − HIPAA 5010 Compliance Date October 1, 2013 − ICD-10 Compliance Date
• All electronic claims must use Version 5010
• Version 4010 claims are no longer accepted
• Claims for services provided on or after this date must use ICD-10 codes for medical diagnosis and inpatient procedures
HIPAA Migration
HIPAA migration to ASC X12 Standard Version 5010 facilitates the U.S. transition to an electronic healthcare environment. HIPAA adoption of 5010 is a precursor to ICD-10 implementation, which includes new guidelines for claims, eligibility inquiries, referral authorization, remittance advice, and more. It adopts an updated version of the National Council for Prescription Drug Programs (NCPDP) and also follows the standards set for Medicaid pharmacy subrogation transactions.
ICD-10 Migration
The US Department of Health and Human Services (HHS) has proposed a regulation that will replace the ICD-9-Clinical Modification code sets, used to report healthcare diagnoses and procedures, with the new advanced and expanded ICD-10 code sets. Transitioning to new ICD-10 coding requires IT system upgrades with the following results.
• Increased code set from 18000 to ~140000
• Structural changes for the codes to Alphanumeric from Numeric format
• Code size increased to 7 character from 5 character length contributing to higher data volumes
Impact of the ICD -10 Adoptions across Healthcare Systems
About 138 countries have adopted ICD-10 for mortality data purposes, and 99 countries have adopted it for morbidity. While ICD-10 paves the way for greater collaboration, innovations in diagnosis and treatment, and in the end, better coordination of benefits and care for the healthcare consumer, the impact will be felt on everything from reimbursement to quality management research and health policy.
GSS Infotech’s Services and Solutions for Regulatory Compliance
GSS Infotech helps you in efficient ICD-10 translation. We have the right people with the right skill set required for healthcare organizations, helping them with compliance mandates for HIPAA and ICD conversion. GSS approach is supported by proprietary in-house regulatory compliance suite to accelerate the transition, while saving costs. In order to help you adopt the new coding system, GSS Infotech offers comprehensive consulting, education, training and specialized end-to-end testing (both internal and external trading partner).
For more information on this, log on to www.gssinfotech.com
