Section 10109

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.