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In effect, the net result of CMS implementing its HIPAA
TCS contingency plans is that it lets the entire industry off the hook for
compliance. The "reasonable time frame" aspect will be interesting to observe re
how long that time frame will be.
On the other hand, the big payers will only let the
submitters/providers slide so long and then they must be able to begin
leveraging their investment in the new EDI technical infrastructure. My crystal
ball is that this *bye* will last through the end of 2003 and then the big
payers will start muscling tie providers - either through new provider network
participation contracts which will required all EDI submissions or by a
substantial surcharge for each paper claim - or both.
What do you think?
Rachel
Rachel
Foerster
Chief Executive
Officer
Rachel Foerster &
Associates, Ltd.
Ideas –
Products - Innovation
39432 North
Avenue
Beach
Park, IL
60099
Voice:
847-872-8070
email: [EMAIL PROTECTED]
http://www.rfa-edi.com
MEDICARE
NEWS
FOR IMMEDIATE RELEASE
CMS Public Affairs
Office
September 23,
2003
MEDICARE
ANNOUNCES PLAN TO ACCEPT HIPAA NON-COMPLIANT ELECTRONIC
TRANSACTIONS AFTER
OCTOBER 16 COMPLIANCE DEADLINE
The Centers for Medicare & Medicaid
Services (CMS) announced today that
it will implement a contingency plan to
accept noncompliant electronic
transactions after the October 16,
2003 compliance
deadline. This plan
will ensure continued processing of claims from
thousands of providers
who will not be able to meet the deadline and
otherwise would have had
their Medicare claims
rejected.
"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.
CMS made the decision to implement its contingency plan after
reviewing
statistics showing unacceptably low numbers of compliant claims
being
submitted.
"Medicare is able to process HIPAA-compliant
transactions," said
Tom Grissom, director of CMS' Center for Medicare
Management, "but
we need to work with our trading partners to increase the
percentage of
claims in production."
The contingency plan permits
CMS to continue to accept and process
claims in the electronic formats now
in use, giving providers additional
time to complete the testing
process. CMS will regularly reassess the
readiness of its trading
partners to determine how long the contingency
plan will remain in
effect.
The authority to implement a contingency plan was provided by
guidance
issued by HHS on July 24. CMS recognized that transactions
often
require the participation of two covered entities and
that
non-compliance by one covered entity may put the second covered
entity
in a difficult position. The guidance stated that covered
entities that
make a good faith effort to comply with HIPAA transactions
and code set
standards may implement contingencies to maintain operations
and cash
flow.
CMS announced its contingency plan on September 11,
but at that time
had not made a decision on whether the plan would be
implemented.
Today's announcement means the CMS plan will be implemented on
October
16, 2003.
"We encourage other plans to assess the readiness
of their trading
partners and implement contingency plans if appropriate,"
Grissom
said.
###
Marcallee
Jackson
Director, Healthcare
Solutions
Edifecs,
Inc
Office (425)
452-0632
Cell:
(425) 681-4858
[EMAIL PROTECTED]
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