HIPAA TCS Compliance Reaches 58 Percent

Baltimore

As of Jan. 2, 58 percent of electronic claims Medicare received were in the transaction code set (TCS) format required by the Health Insurance Portability and Accountability Act, the Centers for Medicare and Medicaid Services said during a January home health, hospice and DME Open Door Forum.

The TCS rule was set to take effect Oct. 16, 2003, but by mid-September last year, fewer than 11 percent of the electronic claims that Medicare received were HIPAA-compliant. As a result, the agency implemented a contingency plan to ease the deadline and ensure continued processing of claims.

Although no new deadline has been announced, according to a CMS spokesperson at the Open Door session, “the contingency plan is only temporary,” and CMS will be ending the contingency as soon as possible. She added that the agency expects a provider to move into full compliance within 30 days following testing of the system.

Additionally, CMS has instructed its contractors to require HIPAA-compliant claims from all providers new to Medicare. “In other words,” the spokesperson stated, “this contingency plan is not applicable to new providers.”

The agency said, however, that the requirement does not apply to certain small providers exempt from filing electronic TCS-compliant claims.

For more information on HIPAA, visit www.cms.gov/hipaa or call 866/282-0659.

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