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Proposed rule aims to reduce paperwork confusion

Tuesday April 10, 2012
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The U.S. Department of Health and Human Services announced a proposed rule that would simplify administrative processes for hospitals, physician’s offices and health insurance plans by establishing a unique identifier for each health plan according to standards of the Health Insurance Portability and Accountability Act of 1996.

The proposed would save healthcare providers and health plans up to $4.6 billion over the next 10 years, according to estimates from HHS. Kathleen Sebelius, secretary of HHS, said the simplifications will allow clinicians to "spend less time filling out forms and more time seeing patients."

Under current rules, when health plans and other entities such as third-party administrators bill providers, they are identified with a wide range of codes that do not have a standard length or format. As a result, healthcare providers may encounter various time-consuming problems such as misrouting of transactions, rejection of transactions because of insurance identification errors and difficulty determining patient eligibility.

The rule simplifies the administrative process for providers by proposing that health plans have a unique identifier of a standard length and format to facilitate routine use in computer systems. This change will allow provider offices to automate and simplify their processes, especially when processing bills and other transactions.

ICD-10 compliance

The proposed rule also delays the requirement for compliance with new codes used to classify diseases and health problems. The compliance deadline is now Oct. 1, 2014, instead of Oct. 1, 2013.

These codes, known as the International Classification of Diseases, 10th Edition diagnosis and procedure codes, or ICD-10, will include new procedures and diagnoses and improve the quality of information available for quality improvement and payment purposes.

Many provider groups have expressed concerns about their ability to meet the 2013 compliance date. The proposed change would give providers and other covered entities more time to prepare and fully test their systems to ensure a smooth and coordinated transition to the new code sets.

More information

For more on the proposed rule for unique identifiers for health plans, visit http://go.cms.gov/ImXxZA. For more on the delay of the deadline for ICD-10 compliance, visit http://go.cms.gov/IANwmp.

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