decisionhealth Newsletters, Coder Pink Sheets - 2012 Issue 5 (May)
CMS proposed rule delaying ICD-10 will require more claims testing
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Article Overview
This article explains a CMS proposed rule that would affect the electronic claims submission process during the ICD-10 delay period. It focuses on upcoming changes for health plans, clearinghouses, and related entities, including the need for additional claims testing, staff preparation, and awareness of implementation timing. The piece is aimed at providers, billing staff, and others who work with payer transactions and standard electronic claims formats.
Why This Topic Matters
The proposed rule could change how claims are routed and processed, creating operational and testing requirements for organizations that submit or handle electronic transactions. Understanding the scope of the rule helps practices prepare for possible disruptions and align internal workflows with new payer identification standards.
Article Sections
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Overview of the proposed rule
Summarizes the CMS proposal and its connection to the ICD-10 delay. Introduces the impact on electronic claims submission and preparation needs.
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Standardized identifiers for health plans and related entities
Describes the move toward standardized identifiers in standard transactions and the general operational issues CMS says it is trying to address.
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Implementation timing and testing expectations
Covers the proposed compliance dates for different plan sizes and the need for staff training and claims testing before implementation.
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Example of a transaction change
Presents a sample transaction field change included in the proposed rule to illustrate the type of claims-submission update discussed in the article.
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Affected organizations and comment period
Lists the categories of organizations impacted by the proposal and notes the public comment period and submission process.
What You Will Learn
- What the CMS proposed rule is addressing at a high level
- Which kinds of organizations may be affected by the proposed transaction changes
- Why additional claims testing may be needed before implementation
- What types of administrative simplification changes are being discussed
- How the proposal relates to electronic claims submission workflows
Who Should Read This
- Medical billing staff
- Coding professionals
- Practice managers
- Revenue cycle teams
- Health plan operations staff
- Clearinghouses and transaction vendors
- Compliance staff
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