HIPAA Regulatory Alert: CMS no longer processing noncompliant claims
HIPAA Regulatory Alert
CMS no longer processing noncompliant claims
CMS: Compliant claims should reduce paperwork
Centers for Medicare & Medicaid Services (CMS) administrator Mark McClellan said the federal government will not process incoming non-HIPAA-compliant Medicare claims submitted for payment on and after Oct. 1, 2005. That decision ended a portion of CMS' HIPAA contingency plan that was in effect since October 2003, under which Medicare continued accepting noncompliant claims after the deadline.
McClellan reported that as of this past June, only some 0.5% of Medicare fee-for-service providers submitted non-HIPAA-compliant electronic claims. The highest rate of noncompliant claims as of May was 1.72% from clinical laboratories. Only 1.45% of hospital claims were noncompliant, and 0.45% of physician submissions.
“We are firmly committed to an interoperable electronic health care system, and the close to 100% compliance with HIPAA standards for claims shows that the health care industry shares this commitment," McClellan said. “Ending the contingency plan for noncompliant claims makes sense. We'll be working with the noncompliant providers . . . with the goal of getting as close to 100% as possible" before the Oct. 1 cutoff.
The agency's contingency plan continues for other electronic health care transactions, but McClellan said he expects to end the contingency plan for those transactions as well in the near future. The remittance advice transaction is the next for which the contingency plan will end.
Important that claims be compliant
Agency officials said submission of HIPAA-compliant claims is a key element in streamlining processing of health care claims, reducing the volume of paperwork, providing better service for providers, insurers, and patients, and cutting costs. Use of HIPAA-compliant claims allows the same software to be used to generate identical claims for all payers using standard formats and coding. Use of all the HIPAA transactions will allow interoperability among payers and providers for health care administration, the officials said.
The law required all payers to conduct HIPAA-compliant transactions no later than Oct. 16, 2003, but only about 31% of Medicare claims were compliant at that time. And other payers had even lower numbers of compliant claims.
To address the problem, CMS established a contingency plan that allowed its trading partners to submit claims in electronic formats currently in use. But the guidance implementing the contingency directed covered entities to make reasonable and diligent efforts to come into compliance and, in the case of health plans, to assist their trading partners to come into compliance. Contingency plans were not to be used indefinitely.
Centers for Medicare & Medicaid Services (CMS) administrator Mark McClellan said the federal government will not process incoming non-HIPAA-compliant Medicare claims submitted for payment on and after Oct. 1, 2005. That decision ended a portion of CMS' HIPAA contingency plan that was in effect since October 2003, under which Medicare continued accepting noncompliant claims after the deadline.Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.