Medicare Compliance & Reimbursement

Are you ready for what the Oct. 16 Health Insurance Portability and Accountability Act transactions and code sets standards deadlines will mean for your bottom line? Anxious that glitches in the early phase of TCS compliance - or non-compliance - will lead to a cash flow disaster, a hospital group is pressing for back-up measures and aggressive preparation, particularly on the part of payors. In a May 19 letter to the Centers for Medicare & Medicaid Services, the American Hospital Association proposes the "development of a system-wide implementation plan that clearly outlines remedial actions that every health plan must take to ensure that an adequate level of cash flow to hospitals is maintained as the field transitions to HIPAA standardized claims."

The association worries that disagreements between providers and payors over what makes for a HIPAA-compliant claim will slow down the money stream and leave hospitals and other providers scrambling for cash. The AHA also calls for pre-deadline, end-to-end transaction testing to ease the transition. Finally, the hospital group says CMS should require plans to identify what they think is wrong with rejected claims so providers can redo them quickly and efficiently. Lesson Learned: Health care providers should brace themselves for possible bumps in the reimbursement road in the early stages of HIPAA TCS compliance.