Just a few bumps on the road to new data standards
In January 2009, HHS published a final rule outlining the steps the healthcare industry must take to update the electronic data transmissions standards used by the financial systems of hospitals, physician offices, claims clearinghouses and payers.
The 34-page final rule called for a 36-month rollout period for the new data exchange standards and urged all affected healthcare organizations to immediately begin taking steps toward conversion to the new standards by Jan. 1, 2012.
So, how is it going thus far? Fairly well, according to a majority—but not all—of the industry experts contacted for this story.
At this point, a little past halfway between the issuance of the rule and its final compliance deadline, providers, clearinghouses and health plans as well as the CMS are moving ahead with modifications to their information technology systems to accommodate the transition from the current family of transaction standards, known as ASC X12 Version 4010, to the new standards, ASC X12 Version 5010.
The 5010 standards bear the name of the Accredited Standards Committee X12, which is a U.S. standards development organization accredited in 1979 by the American National Standards Institute to develop a uniform framework for electronic data interchange. ASC X12 has produced more than 300 EDI standards for government and multiple industries, including healthcare.
Denise Buenning is a senior adviser and team leader at the Office of E-Health Standards and Services at the CMS for the conversion to 5010.
The CMS is “right on target” to make the switch to Version 5010 in its own Medicare feefor-service program, Buenning says.
“They expect to be testing externally in January next year,” he says. “All systems are go.” And elsewhere in the industry, “all the feedback we’re getting, nobody has stepped up and said we’re having an issue on this.”
If there is one dicey area in the changeover to 5010, according to Buenning, it may be with state Medicaid programs.
In comments during rulemaking, some states said that they needed to present funding requests for the conversion to their state legislatures, but to do so, they needed a final rule in hand. A proposed rule on 5010, issued by HHS in August 2008, wasn’t good enough, they said. That’s caused some delays, according to the states.
“We’ve done some initial scanning of the states,” Buenning says. “We’re hearing feedback they’re trying to be ready, but they’re definitely lagging. They have some challenges.”
Buenning says the CMS is working with the states to provide guidance and resources if necessary to see that they get the help they need.
The 5010 standards, like the Version 4010 group in current use, provide uniform messaging capabilities for healthcare transactions such as checking the eligibility of a patient for insurance benefits, the submission and payment of claims and any inquiries and responses regarding the status of claims in process.
The new 5010 standards provide a much needed upgrade—the first full version change in transactions standards in more than a decade. They reflect many of the hundreds of industry requests during the interregnum for improvements to 4010 standards that aim to provide users with clearer instructions, reduce ambiguity among common data elements used in different transactions, and eliminate redundant and unnecessary data elements, according to an American Medical Association primer.
Some of the lesser changes in Version 5010 are merely for good housekeeping, for example, standardizing the location of information in what were called implementation guidelines in the 4010 standards, but are called technical reports in the 5010 standards.
But the crucial change made in the 5010 standard is that it accommodates the switch from the International Classification of Diseases Version 9 family of clinical codes to the far more robust and detailed ICD-10 codes. The deadline for the U.S. launch of ICD-10 is Oct. 1, 2013, set in a separate HHS rule.
In 2000, HHS published the transactions rule for the Health Insurance Portability and Accountability Act of 1996, adopting nine ASC X12 transaction standards for healthcare. HHS has designated ASC X12 as a standards development organization to continue to manage EDI standards under HIPAA.
No meaningful use, yet
Vendors will not be required to demonstrate Version 5010 capabilities when they submit their electronic health-record systems for certification as eligible for federal subsidy payments under Stage I of meaningful-use criteria pursuant to the American Recovery and Reinvestment Act, commonly known as the stimulus law.
A proposed rule for the first round of meaningful-use criteria under the stimulus law was issued by HHS in December 2009. It called for testing an IT system’s claims and eligibility functions, but those requirements were dropped in a simplified final rule HHS issued on July 13.
Still, certification criteria for administrative claims handling are expected to reap-