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
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
For more information on HIPAA, visit www.cms.gov/hipaa or
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