Rule Sets New ICD-10 Deadline and Unique Payer Identifier

A proposed administrative simplification rule from the Department of Health and Human Services would move the ICD-10 compliance date to Oct. 1, 2014, and establish the long-delayed health plan identifier.

The rule also would adopt a data element to serve as an “other entity” identifier for entities that are not health plans, providers or individuals, but need to be identified in standard electronic transactions. Further, the proposed rule also would require “organization covered” health care providers who are prescribers to obtain a National Provider Identifier.

These are physicians or other practitioners who are not covered entities under HIPAA because they do not conduct standard transactions. The 2004 final NPI rule encouraged these providers to obtain a NPI but did not mandate it. In the new proposed rule, HHS acknowledges pharmacies have had issues with getting claims processed because of the lack of a NPI, a problem that has become more troublesome under the Medicare Part D prescription drug benefit program.

The proposed rule has a 30-day comment period starting the date of publication, followed by a final rule published in due course (no time set). The final rule has an expected effective date of Oct. 1, 2012, contingent on when the rule actually comes out. But by targeting October and only having a 30-day comment period, the feds are looking at a fast-track rule making process. The proposed rule is available here and will be published April 17 in the Federal Register.

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