Medicare Agency to Grant Reprieve From HIPAA Electronic-Claims Rule

The Centers for Medicare and Medicaid Services (CMS) has announced implementation of a contingency plan so that the Medicare fee-for-service program continues to accept electronic claims that are not compliant with the Health Information Portability and Accountability Act (HIPAA) now that the October 16 deadline has passed.

This plan ensures continued processing of claims from thousands of providers who were not able to meet the deadline and otherwise would have had their Medicare claims rejected, according to CMS.

“Implementing this contingency plan moves us toward the dual goals of achieving HIPAA compliance while not disrupting providers’ cash flow and operations, so that beneficiaries can continue to get the health care services they need,” said CMS Administrator Tom Scully.

The decision appears to be in response to concerns voiced by APA, the American Medical Association and other medical groups, and government and AMA surveys showing that many physicians are not completely ready for the new standards.

CMS announced its contingency plan on September 11, but did not announce whether the plan would be implemented until September 23.

The AMA has also urged private-sector health plans to do the same. A coalition letter urging the implementation of a contingency plan was sent to Karen Ignani, president and chief executive officer of the American Association of Health Plans, on September 12 and was signed by 50 medical societies and organizations including APA.

HIPAA requires national standards for electronic health care transactions and national identifiers for providers, health plans, and employers. It also addresses the security and privacy of health data. Adopting these standards is expected to improve the efficiency and effectiveness of the nation’s health care system by encouraging the widespread use of electronic data exchange in health care.

“The AMA will continue its work with CMS and private payers up to and beyond the deadline to ensure that claims are processed promptly and the transition to standardized electronic claims processing functions smoothly,” the AMA said in a press statement. “The only way the medical community can avoid disruption in medical-claims processing is if stakeholders—physicians, government, and private payers—each [does its] part toward the common good of a smooth transition to the new transaction standards.”

APA has posted a range of HIPAA education materials on APA’s Web site at www.psych.org/pub_pol_adv/hipaa/index.cfm. These include compliance guidelines, frequently asked questions, and other resource links. In the Members Corner section of the Web site, APA members can also access a HIPAA Bulletin Board to ask HIPAA-related questions, view previously posted questions and answers, and read responses prepared by HIPAA experts. HIPAA staff training and additional compliance materials are also available. ▪