Health Information Compliance Alert

Published on Fri Jan 04, 2013 PDF

Fresh off its much-anticipated release of the  security rule standards, the Department of Health  and Human Services is steaming ahead with final  modifications to the HIPAA transaction standards,  the rule that defines uniform, mandatory technical  specs for electronic health care transactions.

The White House’s Office of Management  and Budget completed its review of the Modification  to the Transactions and Code Sets Final Rule Feb. 10,  and the final version of the regulation was published
Feb. 20 in the Federal Register.

The modifications provide some “breathing  room” for some small providers that did not submit  compliance plans to HHS so that they could receive  a one-year extension of the transactions rule compliance
date to Oct. 16, 2003, says Jarrell Williamson  with the Washington office of Reed Smith.

Williamson says some health plans say  they won’t accept non-standard transactions from  those providers “because, technically, those providers  are under a current obligation to submit  standard transactions,” he adds.

Williamson explains that the TCS modifications have created some leeway for these providers. That’s because HHS has taken the position that if the health plan has obtained a compliance extension or is a small health plan, a provider that has not received an extension is not required to conduct transactions with that health plan in standard form until Oct. 16, 2003.

Williamson says that in situations where a CE is neither a small health plan nor under a compliance extension, HHS has indicated that it won’t aggressively seek to penalize non-compliance with standards because of its own delay in issuing modifications. Rather, he tells Eli HHS intends to “work with providers to bring them into compliance through mechanisms such as corrective action plans.”

The rule also adopts modified standards for two transactions not included in the proposed rules: premium payments and coordination of benefits.

To read the rule in its entirety, go to http://www.cms.hhs.gov/regulations/hipaa/cms0003-5/0003ofr2-10.pdf.