MEDICARE TAKES FURTHER STEPS TO PROMOTE THE USE OF HIPAA STANDARDS FOR ELECTRONIC CLAIMS
Electronic Medicare claims that do not meet Health Insurance Portability and Accountability Act (HIPAA) standards will be treated as paper claims and paid more slowly than HIPAA-compliant electronic claims beginning July 1next week, Mark B. McClellan, M.D., Ph.D., administrator of the Centers for Medicare & Medicaid Services (CMS) reminded today.
"The great majority of electronic claims we are receiving meet the required HIPAA standards," McClellan said, "but for the those still not in compliance there is going to be a delay in getting their money. We are hoping this will motivate more filers to get into compliance soon."
Under a modification to its HIPAA contingency plan announced in February, non-compliant electronic claims will still be accepted by Medicare, but their payment will take 13 additional days. The modification has an effective date of July 1, but CMS has said it will begin delaying payments for non-compliant claims submitted on July 6 and thereafter.
"By working collaboratively with health care providers on the use of standard electronic claims, we've been able to reach 90 percent compliance," McClellan said. "Now, a two-week payment delay is an important further incentive to get to 100 percent."
HIPAA requires that health care claims submitted electronically be in a format that complies with the applicable electronic transaction standard adopted for national use. While the HIPAA electronic transaction standards that were adopted apply to all covered transactions by covered entities, this modification to the CMS compliance plan will only affect covered entities submitting Medicare claims to a Medicare contractor.
By law, Medicare pays compliant electronic claims no earlier than the 14th day after the date of receipt. Non-electronic claims cannot be paid earlier than the 27th day after the date of receipt. By treating non-compliant electronic claims as paper claims, Medicare will pay them 13 days later than compliant electronic claims.
The deadline for compliance with HIPAA electronic transaction standards passed on Oct. 16, 2003, but Health and Human Services Secretary Tommy G. Thompson announced prior to that date that payers would be allowed to implement contingency plans allowing additional time for members of the health care community to come into compliance with the HIPAA electronic claims standards. CMS implemented a contingency plan for electronic Medicare claims and urged private payers to adopt similar plans.
The contingency plan has assured a cash flow to Medicare providers while they worked to meet HIPAA standards.
Filers needing additional help are encouraged to contact their fiscal intermediaries (FIs) or carriers, the private contractors that process and pay Medicare claims.
Additional help can be found on the CMS website.