HIPAA Regulatory Alert

Medicare to make greater use of the Internet

Data on non-HIPAA-compliant claims captured

Medicare continues to work closely with contractors, providers, billing agents, clearinghouses, and software vendors to achieve HIPAA goals and will be making greater use of the Internet and working on implementation of electronic attachments to electronic medical records. That’s the assessment of Gary Kavanagh from the Centers for Medicare & Medicaid Services’ (CMS) Office of Information Services at the Ninth Annual HIPAA Summit in September.

As of the week of Aug. 2-6, 2004, he said, 96.74% of all electronic claims were in HIPAA format, 98.3% of claims processed by intermediaries were in HIPAA format, and 96.34% of claims processed by carriers were in HIPAA format. There are 63,160 current electronic receivers, he said, with 48% of them (30,551) in production on HIPAA.

CMS is consolidating the claims crossover process, known as the Coordination of Benefits Agreement (COBA) initiative, according to Kavanagh. A small number of trading partners are beta testing the process through Oct. 24. If the test is successful, it will move into full production status, with all remaining trading partners transitioning to the national COBA process during FY 2005.

Beginning last July, CMS started capturing additional data on non-HIPAA-compliant electronic claims, reported Kavanagh. The data are state-specific and are broken out by provider type. They will be used to support outreach efforts and any decision to end the Medicare electronic claims contingency plan.

Compliance with submission of claims in HIPAA format improved considerably, he said, once CMS announced that effective July 1, 2004, noncompliant electronic claims would be paid after 27 days, the same as paper claims.

Kavanagh also discussed CR 3031, which was published for implementation in July and conforms Medicare billing requirements to the data content and format requirements in HIPAA, affecting only institutional providers. He said CMS made the changes outlined in CR 3031 to facilitate coordination of benefits transactions (500 million Medicare claims crossing over to third-party payers) that would have been rejected.