New Office Will Help Physicians File Medicare Claims Electronically

A new office in the federal Centers for Medicare and Medicaid Services (CMS) will help health care professionals, insurance plans, and information companies comply with the requirements for electronically filing claims by the deadline of October 16, 2003.

A law enacted last year gave these health care entities a one-year reprieve from the original deadline of October 16 of this year for meeting the electronic billing and coding requirements if they filed for an extension by this past October 15, CMS spokesperson Dan McLeod told Psychiatric News.

Health care entities exempt from that deadline were small health care plans, which have until 2004 to file for an extension, and health care professionals with fewer than 10 employees (Psychiatric News, March 15).

The term “electronic transactions” refers to the transmission of administrative or financial information related to health care, according to CMS. Code sets apply to ICD-9 diagnostic codes and CPT procedure codes.

CMS will not take a punitive approach toward health care entities that it determines through complaints did not file for the one-year extension and are out of compliance with the regulations, said McLeod. Instead, CMS will provide guidance including publishing a new regulation and technical assistance to ensure that health care entities are in compliance by next October 16, he explained.

After that, CMS will take more forceful actions against them, he added.

Regulations Developed

CMS is responsible for developing regulations and enforcement processes for the administrative simplification provisions of the 1996 Health Insurance Portability and Accountability Act (HIPAA).

This includes transactions and code sets, security of online transmissions, and identifiers for health care providers, employers, and insurers for use in electronic transactions, according to a press release from the U.S. Department of Health and Human Services (HHS).

“HIPAA administrative simplification is going to streamline and standardize the electronic filing and processing of health insurance claims, save money, and provide better service for providers, insurers, and patients,” said HHS Secretary Tommy Thompson in the press release.

Duties of New Office

The new CMS office will enforce the HIPAA insurance portability requirements, while the HHS Office of Civil Rights (OCR) will enforce the HIPAA privacy standards finalized this year by HHS.

CMS and OCR will work together on educational efforts to health care entities, enforcement, and other mutual activities such as application of security standards, states the release.

A fact sheet on the HIPAA administrative simplification standards is posted on the Web at www.hhs.gov/news/press/2002pres/hipaa.html. More detailed information about the standards is posted at www.cms.hhs.gov/hipaa. ▪