HIPAA anxiety: Will it be Y2K all over again?

Tuesday, September 30, 2003

HIPAA anxiety: Will it be Y2K all over again?

WASHINGTON - Roughly 94% of Medicare Part B providers may expect to meet the Oct. 16 deadline for HIPAA’s electronic transaction standards and code sets, but that doesn’t mean they’re breathing easy.

Among the top worries plaguing providers regarding the latest HIPAA requirement: Will payers reduce reimbursement when they switch from their own local codes to HIPAA’s universal codes? While the DMERCs appear ready to go, rumors abound about the readiness of state Medicaid programs and other private payers. If Medicaid and private payers can’t process the new format, how will cross-over payments from Medicare be handled?

The common concern with these worries: If payers aren’t ready, will it slow down reimbursement?

“By the end of this year or early next year, there could be a lot of upset people,” said rehab provider Fran Burke, owner of Burke Medical Equipment in Chicopee, Mass. “Or it could be like Y2K. We could be sitting here saying, ‘I’m glad none of that happened. We dodged a bullet.’ I’m more inclined to think it will be between those two extremes. Were going to have some disruption.”

AAHomecare Senior Vice President of Government Affairs Asela Cuervo acknowledged provider concern over HIPAA’s electronic transaction standards and code sets.

“The DMERCs are coming along, but we are hearing that at the state level there are issues with cross-over claims,” Cuervo said. “That’s very big and appears to be widespread and affects 20% of the payment that providers receive.”

CMS did not return calls for this story.

When it comes to cross-over payments and other concerns, that’s another story. It appears that all providers can do is wait for the Oct. 16 deadline and see what happens.

“The way for providers to look at this is to say, I’m ready. I‘ve done my part even if the payers are ready or not,” said healthcare attorney Elizabeth Hogue.