HIPAA Regulatory Alert

New rule would update rules for etransmissions

On Aug. 22, 2008, the Department of Health and Human Services (HHS) published a proposed rule that would adopt updated versions of the standards for electronic transactions under HIPAA. The rule also would adopt a transaction standard for Medicaid pharmacy subrogation and two standards for billing retail pharmacy supplies and professional services, and would clarify who the "senders" and "receivers" are in the descriptions of certain transactions. Comments on the proposed rule closed in October.

Updated versions of current HIPAA electronic transaction standards require the use of the ICD-10 code sets for claims, remittance advice, eligibility inquiries, referral authorization, and other widely used transactions. The proposed version, version 5010, adds the ability to designate certain information as confidential and restrict access to member information. This new function provides privacy protection by safeguarding confidential information, according to HHS.

Health care stakeholders, including the American Hospital Association and Blue Cross/Blue Shield, have asked HHS to forestall requiring implementation of ICD-10 until HIPAA electronic transaction standards have been modified to keep up with the massive coding changes.

"Before the transition to ICD-10 can begin, the industry must move to the next generation of HIPAA transactions [Version 5010] because the current version [4010] will not work with ICD-10," Blue Cross/Blue Shield stated in response to the proposal. "Version 5010 is a major rewrite of the HIPAA transaction standards, with more than 850 individual changes. There is wide industry consensus ... that upgrading to version 5010 is too significant to be done in conjunction with ICD-10."

The ICD-10 changes are scheduled to become effective Oct. 1, 2011. To read the entire proposed rule regarding version 5010, go to edocket.access.gpo.gov/2008/pdf/E8-19296.pdf.