HHS will NOT extend deadline for Electronic Claims
September 12, 2003

HHS yesterday announced that it will not seek to extend the Oct. 16 compliance deadline for the HIPAA transactions and code sets rule for electronically submitting health care claims, CongressDaily reports.

CMS is trying to ensure that the health system does not come to a “screeching halt” if providers stop getting paid because they or those they do business with are unable to file or accept claims electronically, CongressDaily reports. CMS is both the enforcer of the rule and, through Medicare, the largest payer.

Though Medicare and other payers will probably find ways to pay non-compliant providers that are making “good faith efforts” to comply, it’s possible that many providers will have their funding halted, said Leslie Norwalk, acting deputy administrator of CMS. Norwalk also said she is more concerned about payers being unprepared to accept new claims than about their providers being unprepared to submit them, CongressDaily reports (Rovner, CongressDaily, 9/11).

At the beginning of August, only 11% of Medicare’s transactions with providers met the electronic transaction standards, the Wall Street Journal reports. Small or rural providers were the least ready for the upcoming deadline. CMS can fine non-compliant providers or payers $100 per offense up to $25,000 per year. However, the agency said that enforcement would be prompted by complaints, the Journal reports. Agency officials said that their efforts have been hampered because people confuse the transaction standards with the medical privacy rule, which are both part of HIPAA (Lueck, Wall Street Journal, 9/12).

CMS is currently assessing the readiness of health care providers, payers and fiscal intermediaries to decide whether to enact a contingency plan for the HIPAA transactions and code sets rule. If CMS deploys its contingency plan, Medicare would continue to accept and send transactions in current formats while providers and others worked toward implementing the HIPAA standards. The agency said it would decide whether it should deploy its contingency plan by Sept. 25

Posted to HIPAAcomply 9/10/03