Administrative Simplification and ICD-10: Streamlining Health Care Operations

By: Christine Stahlecker, Director, Administrative Simplification Group, Office of E-Health Standards and Services, Centers for Medicare & Medicaid Services

Did you know that the United States spends more than $150 billion annually on health care administration, and for the average physician, two-thirds of a full time employee is needed to carry out billing and insurance related tasks?

To ease these financial and administrative burdens, the Health Insurance Portability and Accountability Act (HIPAA) and the Patient Protection and Affordable Care Act (Affordable Care Act) established administrative simplification requirements. These requirements are in place to lower costs, create uniform electronic standards, and streamline exchanges between health care providers and payers.

We at the Centers for Medicare & Medicaid Services (CMS) are charged with carrying out and enforcing the administrative simplification requirements for HIPAA-covered entities, which include health care providers that conduct certain transactions in electronic form, health care clearinghouses, and health plans.

The administrative simplification mandates require the adoption of operating rules for each of the HIPAA Administrative transactions; a unique, standard Health Plan Identifier (HPID); and standards and operating rules for electronic funds transfers (EFT) and claims attachments.

Two key components of administrative simplification are Version 5010 and ICD-10. Version 5010 modified standards for electronic transactions and created the platform to support the expanded ICD-10 code sets. The ICD-10 code sets convey clinical advances in health care and current medical protocols in the administrative transactions.

If you are attending the HIMSS13 conference and would like to hear more about these initiatives, be sure to catch our ICD-10 and Administrative Simplification session (Education Session 131) on March 6, 2013, 8:30 – 9:30 am. And please stop by our booth (#2868) in the exhibit hall.

We also have helpful resources to help you stay up to date on ICD-10 and other administrative simplification initiatives.

Visit our ICD-10 website for the latest news and resources to help you prepare for the October 1, 2014, deadline. And be sure to check out the ACA website and sign up for Administrative Simplification Updates.

Lastly, follow us on Twitter @CMSGov using #ICD10 and #CMSeHealth. You can also use the official HIMSS hashtag #HIMSS13 to join in on all conference related topics.

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