Home Health & Hospice Week

Oct. 1 looms as drop-dead date for electronic claims compliance.

If you've been putting off your HIPAA billing compliance, your time is just about up.

Starting on Oct. 1, 2005, Medicare will no longer reimburse your non-Health Insurance Portability and Accountability Act-compliant electronic claims.

The Centers for Medicare & Medicaid Services announced Aug. 4 that the contingency plan for accepting electronic claims that don't comply with HIPAA will end.

If you submit Medicare claims after Oct. 1 that don't meet HIPAA standards, CMS will return them to you unprocessed. You will then need to resubmit the claims in a compliant format.

CMS doesn't believe compliance will be a big problem, because as of June 2005, less than 4 percent of Medicare fee-for-service providers submitted non-HIPAA-compliant electronic claims, CMS says in a Medlearn Matters article (MM3956). More than 99 percent of claims submitted in June were in HIPAA-compliant formats.

"Considering the number of all active Medicare providers, it is clear that the Medicare provider community at large has done an outstanding job of adopting the HIPAA claims formats," CMS says. "Therefore, Medicare will end its HIPAA contingency plan for claims submission."

The agency will also continue to make sure providers can get free or low-cost software through their Medicare intermediaries and carriers, it says.

Note: The Medlearn Matters article is at www.cms.hhs.gov/medlearn/matters/mmarticles/2005/MM3956.pdf. For more information on HIPAA, see Eli's Health Information Compliance Alert and HIPAA Training Alert at www.elihealthcare.com.