Following pleas from healthcare
providers, software vendors and billing clearinghouses, CMS
will give its first guidance on compliance with the HIPAA
transaction regulations next week, the agency says.
A
CMS spokesperson confirmed today that the Medicare agency will
provide guidance sometime next week after numerous
organizations complained to HHS Secretary Tommy Thompson that
there is not enough time to complete electronic claims testing
with all payers prior to the Oct. 16 compliance deadline.
The spokesperson says CMS officials are trying to
figure out whether the HIPAA statute or the rule on
transactions and code sets allows for any "wiggle room."
According to the spokesperson, "We have staff that's
working around the clock on this."
The disclosure
comes two days after a trade association representing
clearinghouses and transaction software vendors sent Thompson
a laundry list of concerns.
In its July 15 letter, the
Washington-based Association For Electronic Health Care
Transactions, complains that the inability to test electronic
transactions with many healthcare payers is "the major
obstacle to compliance" with the HIPAA transaction standards.
The organization asks HHS to require Medicare
intermediaries to accept nonstandard claims in addition to
HIPAA-formatted claims--"in essence run parallel systems," the
letter says--and urge other payers to do the same for an
unspecified period of time beyond the October deadline. It
also wants CMS to come up with an electronic provider
enrollment process or otherwise prohibit its contractors from
requiring re-enrollment.
The AFEHCT letter raises many
of the same concerns mentioned in a June 30 letter to HHS from
the AMA, the American Medical Group Association, the Medical
Group Management Association, the American Hospital
Association and 35 specialty medical societies.
AFEHCT
says delays in testing may lead to a "major interruption in
the flow of claims submissions, processing and payments" come
Oct. 16, raising the possibility that physician practices and
hospitals may face a serious cash-flow crunch this fall.
Furthermore, the HIPAA rules are such that if there is
an error in just one claim, payers will return an entire batch
rather than break out the erroneous claim, likely delaying the
payment process, according to AFEHCT.
The group says a
number of payers will not let clearinghouses test electronic
data interchange without first re-enrolling providers that
formerly sent nonstandard claims directly to payers, and
without the clearinghouses signing business associate
agreements with the health plans. A February addendum to the
HIPAA regulations gives covered entities with existing
contracts an additional year beyond this October to finalize
business-associate agreements.
These requirements are
"obstacles to compliance and obstacles to testing," says
AFEHCT Executive Director Tom Gilligan.
AFEHCT also
complains that some health plans are adding their own
"companion guides" to the official HIPAA implementation
guides, effectively adding payer-specific data elements to
what should be standardized code sets and forcing providers
and clearinghouses to tailor claims to individual payers.
"Nowhere in the statute or the regs are the words
'companion guides' ever mentioned," Gilligan says. "But the
language shows up in contracts even for testing. This is an
impediment to being able to continue the flow of claims and
transactions."
