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HIPAA Reprieve: Five More Days for Compliance

Medicare providers now have a few more days to file electronic claims that do not contain all the information required by the Health Insurance Portability and Accountability Act. The Centers for Medicare and Medicaid Services, or CMS, had planned to treat non-HIPAA compliant electronic claims as paper claims starting July 1, but has now said […]

Written By

M.L. Baker

Jul 1, 2004

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Medicare providers now have a few more days to file electronic claims that do not contain all the information required by the Health Insurance Portability and Accountability Act. The Centers for Medicare and Medicaid Services, or CMS, had planned to treat non-HIPAA compliant electronic claims as paper claims starting July 1, but has now said that it will not do so until July 6.

Another deadline for HIPAA compliance was scheduled for Oct. 16, 2003, but CMS began a contingency plan so that cash flow to providers was not interrupted. HIPAA requires that claims are submitted electronically according to a national electronic transaction standard, but many providers have not been able to meet the goals on time.

Under the current CMS payment system, paper claims are paid 13 days later than are all electronic claims. Now, compliant electronic claims will be paid no earlier than the 14th day after receipt, and paper and non-compliant electronic claims will be paid no earlier than the 27th day after receipt. The change only applies to covered entities submitting Medicare claims to a Medicare contractor.

Mark McClellan, administrator of CMS, said this was an industry-friendly way to push for compliance. “By working collaboratively with health care providers on the use of standard electronic claims, we’ve been able to reach 90 percent compliance. Now, a two-week payment delay is an important further incentive to get to 100 percent.”

CMS urged filers that need help with compliance to contact their fiscal intermediaries (FIs) or carriers, the private contractors that process and pay Medicare claims.

For the CMS listing of Medicare FIs and carriers, click here.

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HIPAA Reprieve: Five More Days for Compliance

M.L. Baker

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