CMS & Palmetto/J1MAC News

The following information has been received by ANCO.


****CMS NEWS****
The U.S. Department of Health and Human Services (HHS) recently released two final rules that will facilitate the United States’ ongoing transition to an electronic health care environment through adoption of a new generation of diagnosis and procedure codes and updated standards for electronic health care and pharmacy transactions.

The first final rule replaces the ICD-9-CM code sets now used to report health care diagnoses and procedures with greatly expanded ICD-10 code sets, with a compliance date of Oct. 1, 2013. The second final rule adopts an updated X12 standard, Version 5010, for certain electronic health care transactions, an updated version of the National Council for Prescription Drug Programs (NCPDP) standard, Version D.0, for electronic pharmacy-related transactions, and a standard for Medicaid pharmacy subrogation transactions. Version 5010 includes updated standards for claims, remittance advice, eligibility inquiries, referral authorization, and other administrative transactions. Version 5010 also accommodates the use of the ICD-10 code sets, which are not supported by Version 4010/4010A1, the current X12 standard.

“These regulations will move the nation toward a more efficient, quality-focused health care system by helping accelerate the widespread adoption of health information technology,” HHS Secretary Mike Leavitt said. “The greatly expanded ICD-10 code sets will fully support quality reporting, pay-for-performance, bio-surveillance, and other critical activities. The updated X12 transaction standards, Version 5010, provide the framework needed to support the ICD-10 codes.”

The ICD-10 rule titled “HIPAA Administrative Simplification: Modifications to Medical Data Code Set Standards to Adopt ICD–10–CM and ICD–10–PCS” is available in text format at http://edocket.access.gpo.gov/2009/E9-743.htm and in pdf format at http://edocket.access.gpo.gov/2009/pdf/E9-743.pdf .

The updated X12 transaction standards, version 5010, rule titled “Health Insurance Reform; Modifications to the Health Insurance Portability and Accountability Act (HIPAA) Electronic Transaction Standards” is available in text format at http://edocket.access.gpo.gov/2009/E9-740.htm and in pdf format at http://edocket.access.gpo.gov/2009/pdf/E9-740.pdf .

A fact sheet describing both rules may be viewed at: http://www.cms.hhs.gov/apps/media/press/factsheet.asp?Counter=3407&intNumPerPage=10&checkDate=&checkKey=&srchType=1&numDays=3500&srchOpt=0&srchData=&keywordType=All&chkNewsType=6&intPage=&showAll=&pYear=&year=&desc=&cboOrder=date.


****PALMETTO/J1MAC NEWS****
Emergency Update to the 2009 Medicare Physician Fee Schedule Database
(MPFSDB)
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20A~MLNs~General~Emergency%20Update%20to%20the%202009%20Medicare%20Physician%20Fee%20Schedule%20Database%20(MPFSDB)?opendocument

CR 6351 is a J1 Part A and B article titled Emergency Update to the 2009
Medicare Physician Fee Schedule Database (MPFSDB).