[ Monday, March 08, 2004 ]


Non-HIPAA claims to Medicare will get slow pay treatment. As you probably know, October 16, 2002 was the original deadline for most covered entities to convert to HIPAA-compliant formats and data sets. Of course, as that date was impending and it was clear that nobody would be ready, HHS allowed anyone who wanted to "apply" for a one-year extension of the deadline. So October 16, 2003 became the deadline. Of course, as that date was impending and it was clear that a lot of folks still would not be ready, HHS announced a "contingency plan" to allow non-HIPAA compliant electronic claims to still be processed. So since October, electronic claims have been paid by CMS, whether they're HIPAA-compliant or not. As of early March, only 69% of claims presented to CMS were HIPAA-compliant. At least that represents a steady rise, from about 30% on the October start date and a little over 50% on December 12.

That is about to change. On February 27, CMS issued a release outlining a new policy that non-HIPAA-compliant electronic claims would be treated as paper claims. Electronic claims are paid in 14 days, while paper claims are paid in 27 days. The purpose of this disparity is to encourage electronic claims (additionally, most larger providers are required to submit electronic claims). Since HIPAA-compliant electronic claims will be paid faster, this should incentivize some electronic claims filers using old systems to switch to HIPAA-compliant systems.

This should also serve as notice that CMS may well cut off the tap entirely for non-HIPAA-compliant electronic claims in the future. The contingency plan, when announced, had no end date. However, this may be an early indication that HHS is prepared to shut off the contingency plan at some point in the future.

UPDATE: I forgot to mention that the slower-pay policy comes into effect July 1.

Jeff [11:29 AM]

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