Reimbursement

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Monday, May 31, 2004

What’s coming up for HIPAA
With Maureen Hanna

Q. Could you review the upcoming changes we can expect from the just released CMS revised contingency plan for HIPAA?

A. To support the goal to move providers to using HIPAA compliant electronic formats in effect October 15, 2003, Health and Human Services in their July 24, 2003 contingency plan encouraged all to comply with HIPAA standards requirements as soon as possible. Therefore, CMS recently modified its contingency plan to only pay claims submitted in a HIPAA compliant format as early as the 14th day after payment.

Beginning July 1, 2004 all claims submitted in a pre-HIPAA format (e.g. National Standard Format) or an earlier version of ANSI (e.g. 4010A1 X12 827) will not be paid earlier than the 27th day after date of receipt.

What this means is that if you are still submitting claims in old formats, you must prepare your organizations for a delay in cash flow. Your claims will be considered the same as paper and will take an additional 13 days for payment.

Should you wish to obtain more detailed information go to the CMS Web site: www.cms.hhs.gov/hipaa/hipaa2/default.asp.

Maureen Hanna may be reached at Maureen@HMEconsultant.com.

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