CMS Slows Non-TCS-Compliant Claims

Baltimore

After announcing its intentions earlier this year, beginning July 6 CMS slowed processing of non-HIPAA-compliant claims — paying them no earlier than 27 days after receipt — to encourage use of the standardized transactions and code sets (TCS) format.

According to CMS, about 87.5 percent of all Medicare providers are currently filing electronic claims in the TCS-compliant format. But, said a CMS official at a June 23 Home Health, Hospice and DME Open Door Forum, “that’s definitely not in the ballpark of 100 percent.”

In a June 30 statement, CMS Administrator Mark Mcclellan said “for those still not in compliance, there is going to be a delay in getting their money. We are hoping this will motivate more filers to get into compliance soon.”

By law, Medicare pays compliant electronic claims no earlier than the 14th day after the date of receipt. Non-electronic claims cannot be paid earlier than the 27th day after the date of receipt. By treating non-compliant electronic claims as paper claims, Medicare will pay them 13 days later than compliant electronic claims.

Shortly before CMS’ original compliance deadline of Oct. 16 last year, the agency enacted a contingency plan to ensure cash flow to Medicare providers by allowing them to continue to submit non-HIPAA-compliant claims as long as they showed a “good faith effort” toward compliance.

The agency has not yet announced a new deadline for when CMS will stop accepting non-HIPAA-compliant claims.

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