CMS Sets October Deadline for HIPAA-Compliant Claims

BALTIMORE–Beginning Oct. 1, CMS will no longer process claims
not compliant with the Health Insurance Portability and
Accountability Act, Administrator Mark McClellan announced
Thursday.

The original deadline for HIPAA-compliant transactions–designed
to allow for interoperability among payers and providers by
generating identical claims using standard formats and coding–was
Oct. 16, 2003. But CMS put the enforcement plan on hold because
only about 31 percent of Medicare claims were compliant at the
time.

On July 5, the agency stopped accepting paper claims, except for
those meeting certain exemption criteria, but will continue to
accept claims with non-HIPAA compliant code sets until October.

Now it appears that most health care providers are on board. As
of June, only about 0.5 percent of Medicare fee-for-service
providers submitted non-HIPAA compliant electronic claims,
according to CMS.

“We are firmly committed to an interoperable electronic health
care system, and the close-to-100-percent compliance with HIPAA
standards for claims shows that the health care industry shares
this commitment,” McClellan said.

A survey released Aug. 1 by the Healthcare Information and
Management Systems Society indicated lower levels of HIPAA
compliance overall in the health care industry. The survey found
that 78 percent of health care providers and 90 percent of payers
are compliant with HIPAA transactions and code sets. The same
number are compliant with the law’s security rule, which took
effect two years ago, the study said. An average of 55 percent of
both groups said while their information systems can produce
transactions, their trading partners can’t accept or transmit
them.

For more information, visit www.cms.hhs.gov/hipaa.