CMS takes a lenient, complaint-driven approach to enforcement - HIPAA Update

Health Management Technology, Sept, 2003

With the Oct. 16 deadline for compliance with HIPAA electronic transactions and code sets (TCS) standards just weeks away, the Centers for Medicare and Medicaid Services (CMS) will offer no extensions. However, CMS has said it will "focus on obtaining voluntary compliance and use a complaint-driven approach" to enforce the provisions.

The agency will consider good faith efforts to come under compliance and will not penalize covered entities that have established contingency plans. That includes cases where a trading partner hampers an entity's ability to comply with the TCS requirements. For example, if a health plan can "demonstrate to CMS its active outreach/testing efforts [with trading partners], it can continue processing payments to providers."

A number of industry groups including AAHP, MGMA, the American College of Physicians and the Workgroup for Electronic Data Interchange have expressed concern that a sizeable number of providers and payer entities may not be able to comply with the deadline. According to an April Gartner survey, fewer than 60 percent of providers were ready for formal transactions testing.

In June, MGMA and 40 medical organizations asked HHS to temporarily allow physician practices to submit claims in their old, proprietary formats. While permission wasn't forthcoming, MGMA says the formal CMS guidance document does take physician practice concerns into consideration. For the latest HHS news on HIPAA compliance, go to www.rsleads.com/309ht-226.>

COPYRIGHT 2003 Nelson Publishing

COPYRIGHT 2004 Gale Group