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Statutory Text

SEC. 10109. DEVELOPMENT OF STANDARDS FOR FINANCIAL AND ADMINISTRATIVE
TRANSACTIONS.
(a) ADDITIONAL TRANSACTION STANDARDS AND OPERATING
RULES.—
(1) DEVELOPMENT OF ADDITIONAL TRANSACTION STANDARDS
AND OPERATING RULES.—Section 1173(a) of the Social Security
Act (42 U.S.C. 1320d–2(a)), as amended by section 1104(b)(2),
is amended—
(A) in paragraph (1)(B), by inserting before the period
the following: ‘‘, and subject to the requirements under
paragraph (5)’’; and
(B) by adding at the end the following new paragraph:
‘‘(5) CONSIDERATION OF STANDARDIZATION OF ACTIVITIES
AND ITEMS.—
‘‘(A) IN GENERAL.—For purposes of carrying out paragraph
(1)(B), the Secretary shall solicit, not later than January
1, 2012, and not less than every 3 years thereafter,
input from entities described in subparagraph (B) on—
‘‘(i) whether there could be greater uniformity in
financial and administrative activities and items, as
determined appropriate by the Secretary; and
‘‘(ii) whether such activities should be considered
financial and administrative transactions (as described
in paragraph (1)(B)) for which the adoption of standards
and operating rules would improve the operation
of the health care system and reduce administrative
costs.
‘‘(B) SOLICITATION OF INPUT.—For purposes of subparagraph
(A), the Secretary shall seek input from—
‘‘(i) the National Committee on Vital and Health
Statistics, the Health Information Technology Policy
Committee, and the Health Information Technology
Standards Committee; and
‘‘(ii) standard setting organizations and stakeholders,
as determined appropriate by the Secretary.’’.
(b) ACTIVITIES AND ITEMS FOR INITIAL CONSIDERATION.—For
purposes of section 1173(a)(5) of the Social Security Act, as added
by subsection (a), the Secretary of Health and Human Services (in
this section referred to as the ‘‘Secretary’’) shall, not later than
January 1, 2012, seek input on activities and items relating to the
following areas:
(1) Whether the application process, including the use of a
uniform application form, for enrollment of health care providers
by health plans could be made electronic and standardized.
(2) Whether standards and operating rules described in
section 1173 of the Social Security Act should apply to the
health care transactions of automobile insurance, worker’s
compensation, and other programs or persons not described in
section 1172(a) of such Act (42 U.S.C. 1320d–1(a)).
(3) Whether standardized forms could apply to financial
audits required by health plans, Federal and State agencies
(including State auditors, the Office of the Inspector General of
the Department of Health and Human Services, and the Centers
for Medicare & Medicaid Services), and other relevant entities
as determined appropriate by the Secretary.
(4) Whether there could be greater transparency and consistency
of methodologies and processes used to establish claim
edits used by health plans (as described in section 1171(5) of
the Social Security Act (42 U.S.C. 1320d(5))).
(5) Whether health plans should be required to publish
their timeliness of payment rules.
(c) ICD CODING CROSSWALKS.—
(1) ICD–9 TO ICD–10 CROSSWALK.—The Secretary shall task
the ICD–9–CM Coordination and Maintenance Committee to
convene a meeting, not later than January 1, 2011, to receive
input from appropriate stakeholders (including health plans,
health care providers, and clinicians) regarding the crosswalk
between the Ninth and Tenth Revisions of the International
Classification of Diseases (ICD–9 and ICD–10, respectively)
that is posted on the website of the Centers for Medicare &
Medicaid Services, and make recommendations about appropriate
revisions to such crosswalk.
(2) REVISION OF CROSSWALK.—For purposes of the crosswalk
described in paragraph (1), the Secretary shall make appropriate
revisions and post any such revised crosswalk on the
website of the Centers for Medicare & Medicaid Services.
(3) USE OF REVISED CROSSWALK.—For purposes of paragraph
(2), any revised crosswalk shall be treated as a code set
for which a standard has been adopted by the Secretary for
purposes of section 1173(c)(1)(B) of the Social Security Act (42
U.S.C. 1320d–2(c)(1)(B)).
(4) SUBSEQUENT CROSSWALKS.—For subsequent revisions of
the International Classification of Diseases that are adopted by
the Secretary as a standard code set under section 1173(c) of
the Social Security Act (42 U.S.C. 1320d–2(c)), the Secretary
shall, after consultation with the appropriate stakeholders,
post on the website of the Centers for Medicare & Medicaid
Services a crosswalk between the previous and subsequent
version of the International Classification of Diseases not later
than the date of implementation of such subsequent revision.