Medicare Compliance & Reimbursement

Has CMS done enough to forestall payment disruptions?

Health care providers need more guidance to ensure that the Oct. 16 Health Insurance Portability and Accountability Act transactions rule deadline doesn't create a reimbursement nightmare.    So said the American Hospital Association's George Arges in Aug. 21 comments to the National Committee on Vital and Health Statistics. While the Centers for Medicare & Medicaid Services July 24 guidance is a good "first step ... it fails to create the safety net that can ensure caregivers will continue to receive payment for their services after Oct. 16," Arges said.     What's needed, he affirmed, is a contingency plan with specific action points tailored to minimize disruptions to the payment cycle. The AHA's wish list for future guidance includes:      clarification that health plans can process a claim for payment if it includes non-material errors that don't affect adjudication; clarification that plans shouldn't reject an entire batch transaction if only one or two claims contain errors;      an outline of specific performance expectations for the weeks before Oct. 16;      an affirmation that payments for similar services before and after Oct. 16 shouldn't be different unless a new amount had already been agreed to; and finally      a declaration that the turnaround time for post-Oct. 16 claims should match that of pre-Oct. 16 claims.     Lesson Learned: Health care providers should be doing everything they can to work with their payers to ensure as smooth a transition as possible into HIPAA transactions requirements.