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CCH® BENEFITS — 9/3/08

New Guidelines Proposed For HIPAA Transaction Standards

From Spencer's Benefits Reports: The Department of Health and Human Services has proposed two rules to update transaction standards and code sets for the administrative simplification provisions of the Health Insurance Portability and Accountability Act of (HIPAA). The proposed rules appeared in the August 22 Federal Register.

Standards For Transactions

One of the proposed rules updates versions of the HIPAA standards for electronic transactions

HIPAA standards for electronic transactions first were issued in 2000 and were modified in 2003. This rule also proposes the adoption of a transaction standard for Medicaid pharmacy subrogation, the adoption of two standards for billing retail pharmacy supplies and professional services, and a clarification of who the “senders”and “receivers” are in the descriptions of certain transactions.

The regulations would be effective 60 days after publication of the final regulations.

Organizations covered by the HIPAA standards would need to use the revised rules for the following standards:

• health care claims or equivalent encounter information;
• professional health care claims;
• institutional health care claims;
• dental health care claims;
• dental, professional, and institutional health care;
• eligibility benefit inquiry and response;
• dental, professional, and institutional referral certification and authorization;
• health care claim status request and response;
• enrollment and disenrollment in a health plan;
• health care payment and remittance advice;
• health plan premium payments;
• coordination of benefits;
• dental health care claims;
• professional health care claims; and
• institutional health care claims

Comments on the proposed rule must be submitted by October 21. Electronic comments should be sent to http://www.regulations.gov. Follow the instructions for “Comment or Submission” and enter file code CMS-0009-P to find the document accepting comments. Written comments should be sent to the Centers for Medicare and Medicaid Services, Department of Health and Human Services, Attention: CMS-0009-P, P.O. Box 8014, Baltimore, MD 21244-1850.

For further information, contact Lorraine Doo at (410) 786-6597; or Gladys Wheeler at (410) 786-0273.

Code Set Changes

A second set of proposed rules would modify two of the medical data code set standards in HIPAA.

Specifically, this proposed rule would modify the standard code sets for coding diagnoses and inpatient hospital procedures by adopting the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) for diagnosis coding, and the International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS) for inpatient hospital procedure coding.

The regulations would be effective 60 days after publication of the final regulations.

Comments on this proposed rule must be submitted by October 21. Electronic comments should be sent to http://www.regulations.gov. Follow the instructions for “Comment or Submission” and enter file code CMS-0013-P to find the document accepting comments. Written comments should be sent to the Centers for Medicare and Medicaid Services, HHS, Attention: CMS-0013-P, P.O. Box 8016, Baltimore, MD 21244-8016.

For further information, contact Donna Pickett at (301) 458-4434 for ICD-10-CM, Pat Brooks at (410) 786-5318 for ICD-10-PCS, and Denise Buenning at (410) 786-6711 for other questions.

For more information on this and related topics, consult the CCH Pension Plan Guide, CCH Employee Benefits Management, and Spencer's Benefits Reports.

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