Contingency plan for noncompliant Medicare claims ends

AORN Journal, Sept, 2005

Beginning Oct 1, 2005, the Centers for Medicare and Medicaid Services (CMS) will not process incoming electronic Medicare claims that are not compliant with the Health Insurance Portability and Accountability Act of 1996 (HIPAA), according to an Aug 4, 2005, new release from CMS. Claims that do not meet the standards required by HIPAA will be returned to the filer for resubmission.

All payers were required by law to conduct HIPAA-compliant transactions as of Oct 16, 2003. Only about 31% of Medicare claims were compliant at that time, however, and other payers had even fewer compliant claims. To address this problem, CMS established a contingency plan that allowed its trading partners to submit claims in electronic formats currently in use. Contingency plans were not to be used indefinitely, however, and an enforcement guidance directed covered entities to make reasonable and diligent efforts to come into compliance and, in the case of health plans, to assist their trading partners in coming into compliance.

This change affects claims for services provided under fee-for-service Medicare. The contingency continues for other electronic health care transactions, but CMS expects to end the contingency plan for these transactions in the near future.

To enable electronic submission of HIPAA-compliant claims, CMS continues to make available free and tow-cost software through Medicare carriers and intermediaries. The submission of HIPAA-compliant claims begins a streamlining process that will arrow use of the same software to generate identical claims for all payers using standard formats and coding.

CMS Ending Contingency for Non-HIPAA-Compliant Medicare Claims (news release, Baltimore: Centers for Medicare and Medicaid Services, Aug 4, 2005) http:// www.cms.hhs.gov/media/press/release.asp?Counter=1528 (accessed 8 Aug 2005).