CMS announced that it will not process electronic Medicare claims submitted for payment beginning October 1, 2005, that fail to comply with the Health Insurance Portability and Accountability Act of 1996 (PubLNo 104-191) (HIPAA). Claims that do not meet these standards will not be processed and will be returned to the filer for re-submission.
As of June 2005, 0.5 percent of Medicare fee-for-service providers submitted non-HIPAA compliant electronic claims. "We are firmly committed to an interoperable electronic health care system, and the close-to-100-percent compliance with HIPAA standards for claims shows that the health care industry shares this commitment," CMS Administrator Mark B. McClellan said.
Contingency plan. This action ends a portion of a CMS HIPAA contingency plan that has been in effect since October 16, 2003. Although the law required all payers to conduct HIPAA compliant transactions by that date, only 31 percent of Medicare claims were compliant at the time. In response to the low compliance rate, CMS established a contingency plan that allowed its trading partners to submit claims in electronic formats currently in use. A July 24, 2003, enforcement guidance, however, directed covered entities to make reasonable and diligent efforts to come into compliance.
The contingency continues for other electronic health care transactions, but CMS plans to end the contingency plan for these transactions in the near future. The remittance advice transaction is the next HIPAA transaction for which CMS expects to end its contingency plan.
SOURCE: CMS Release, Aug. 4, 2005.
For more information on this and related topics, consult the CCH® Medicare and Medicaid Guide..
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