Marcalle, Your assumption below that a provider submitting an extension under ASCA automatically declares itself to be a covered entity is not true. CMS/DHHS has repeatedly made this statement so that potentially covered entities, especially providers, do not feel inhibited from filing such an extension request.
I believe that this is also addressed in the various CMS FAQs relative to ASCA. Rachel Foerster -----Original Message----- From: Marcallee Jackson [mailto:[EMAIL PROTECTED]] Sent: Sunday, October 13, 2002 12:22 PM To: [EMAIL PROTECTED] Subject: RE: HIPAA Exemption Jonathan- I am not aware of a definitive answer to this but it would seem that if a provider stops all electronic transactions prior to the deadline of October 16, 2002, they could exempt themselves from HIPAA. To be granted an extension, a provider has to file a work plan for achieving compliance with the Transaction and Code Sets (TCS) rule. I would think a provider who files for the extension has acknowledged itself as a Covered Entity (CE) with a plan for compliance. Also, that provider would need to be compliant with the Privacy rules by April of 2003. So I would say that reverting to paper after filing for the extension would not exempt the provider. For a small provider, reverting to paper for claims might be a workable short term solution for compliance with TCS but for most, it is not a realistic long term strategy for full exemption from HIPAA. Using any electronic HIPAA transaction, including in a Direct Data Entry (DDE) scenario, would cause the provider to meet the definition of a CE under HIPAA and require compliance with all HIPAA's rules. That would mean the provider could never check eligibility on a payer's Web site or complete other tasks online like checking claim status or requesting a referral. That could turn out to be a big drag very soon. In addition, many payer's are expected to follow Medicare's lead and require the use of electronic transactions. Payers are also not expected to support non-compliant code sets for long so even providers conducting paper transactions will have work to do to convert. Finally the cost to the provider who does not conduct HIPAA transactions electronically could easily exceed the cost of compliance. I know of a tool available for free online that allows a provider to calculate the cost of manual transactions and compare those against the cost of electronic. I used the tool to calculate the savings of a provider who sees 125 patients a week. The resultant savings were over $40,000 a year. Plus or minus 20%, the number is pretty compelling. If you would like, email me directly and I'll send a link to the tool. A better plan might be for the provider to acknowledge itself as a CE and file for an extension by quickly developing a high level work plan. Next the provider should purchase an inexpensive tool for Privacy and Security compliance. There are many available today. Complying with these regulations really isn't all that difficult for a small provider. Then, the provider can check out its options for transactions and, if it decides its only option for claims is paper, go ahead and send them that way for as long as they need to or can. But this would still allow the use of other electronic transactions like DDE eligibility, claim status, etc. Hope that helps. Marcallee Jackson Long Beach, CA 562-438-6613 -----Original Message----- From: Jonathan May [mailto:[EMAIL PROTECTED]] Sent: Friday, October 11, 2002 5:09 AM To: [EMAIL PROTECTED] Subject: RE: HIPAA Exemption Thank you for your responses, but just to clarify - I understand the fewer than 10 FTE exemption. I am unclear as to whether this practice, who currently submits electronic claims to Medicare will be exempt from HIPAA requirements if they stop these submissions prior to October 15, 2002? What if they file for an extension, but stop their electronic submissions prior to October 15, 2003? 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Posting of advertisements or other commercial use of this listserv is specifically prohibited. ********************************************************************** To be removed from this list, send a message to: [EMAIL PROTECTED] Please note that it may take up to 72 hours to process your request. ====================================================== The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. Posting of advertisements or other commercial use of this listserv is specifically prohibited.
