Failure To Meet HIPAA Electronic Billing Requirement Before October Deadline May Delay Provider Payments

Health care providers could face delays in payments next month because many are not prepared to meet the Oct. 16 deadline for the new national electronic billing requirement under the Health Insurance Portability and Accountability Act, officials at CMS said yesterday, the Wall Street Journal reports. The new billing standard requires health insurers, hospitals, physicians and claims administrators to use a uniform electronic billing system designed to simplify the claims process, the Journal reports (Lueck, Wall Street Journal, 9/12). The "transaction code set" rules under HIPAA will facilitate the communication of health information, according to CMS Acting Deputy Administrator Leslie Norwalk, CongressDaily reports. Norwalk said the agency is trying to ensure that the health system does not falter if providers are not paid next month because of an inability to file or accept claims under the new system (Rovner, CongressDaily, 9/11). In August, only 11% of Medicare's transactions with health care providers met the new standards, the Journal reports. Small or rural providers appear to be the furthest from compliance (Wall Street Journal, 9/12). However, Norwalk said that HHS will not ask Congress to extend the compliance deadline; lawmakers already delayed the deadline once by a year. She added that CMS will announce Sept. 25 if it will put a contingency plan in place to handle claims after Oct. 16 that are submitted in "legacy formats" (CongressDaily, 9/11). She added that CMS will continue to pay Medicare claims as long as providers are making a "good-faith effort" to adopt the new billing standards, the Journal reports. Although CMS can fine providers $100 to $25,000 per year for non-compliance, officials said any enforcement would be "complaint-driven." In an effort to publicize the new requirement, CMS has launched a print advertisement campaign warning health providers, "Get compliant. Your cash flow depends on it" (Wall Street Journal, 9/12).