Home Health & Hospice Week

Don't let this common HIPAA myth fool you into non-compliance with the transaction standard. If you're a home health agency or hospice with fewer than 25 full-time employees or a supplier with fewer than 10 FTEs, you're home free on HIPAA, right? Wrong. This is one of the most pervasive Health Insurance Portability and Accountability Act myths out there, says attorney John Gilliland II with Indianapolis-based Gilliland & Caudill. First, the exemption the Centers for Medicare & Medicaid Services offers for small providers is an exemption from electronic filing only, which becomes mandatory Oct. 16. It doesn't affect HIPAA privacy requirements already in place, Gilliland stresses. Second, even that narrow electronic filing exception is very limited, CMS stressed in a July HIPAA teleconference aimed specifically at durable medical equipment suppliers.  Electronic Activity Makes you Subject to HIPAA  "Please be aware that even small providers and suppliers are still subject to HIPAA if they are covered entities," said Rachel Seeger, the HIPAA Team Leader for CMS' Region V Chicago Office. What makes you a covered entity, and therefore required to electronically file claims with Medicare? Seeger said engaging in either of these activities will do it: filing electronic claims with Medicare, or checking patients' Medicare eligibility electronically. Additionally, providers that bill only paper to Medicare but bill Medicaid and other insurers electronically also are subject to the HIPAA electronic transaction standard, Gilliland adds. Effectively, "there is no small provider exemption from HIPAA," Gilliland maintains. The only way to secure an exception from HIPAA's electronic filing requirements is to bill all payors via paper and not to check any patient or claims information online. But going back to the paper age is a big mistake, Seeger warned in the teleconference. "Your business processes would be disrupted by having to prepare paper claims and check eligibility and claims status by phone," she said. Also, cash flow would be reduced since Medicare can't pay paper claims until 28 days after receipt of the claim at the soonest. The electronic claims payment floor is 14 days, she pointed out in the call. Electronic claims "reduce the administrative burden, lower operating costs and improve overall data quality," Seeger praised. "Reverting to paper should not be a way of opting out of HIPAA," she concluded. Editor's Note: A transcript of the call is available online at www.mche.us.com/downloads/transcript_71703.pdf.