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Home Health & Hospice Week

HIPAA:

HIPAA Help For The Little Guy

Published on Fri Jul 25, 2003

Small, paper-billing providers can escape the HIPAA transaction rule quagmire.

While health care providers across the country tensely await the Oct. 16 Health Insurance and Portability and Accountability Act transaction rule deadline, certain providers will be able to avoid the mess entirely - but the cost of doing so may be too high.

"A small provider of services or supplier" is exempted from the requirement that all Medicare claims be submitted electronically - and, in most cases, in accordance with HIPAA - by Oct. 16, affirms the Centers for Medicare & Medicaid Services in a notice dated June 24 and posted to its Web site in early July.

To qualify as a small provider or supplier, you must be:

  • a "provider of services" (typically a Part A provider) with fewer than 25 full-time equivalent employees, or

  • a physician, practitioner, facility or supplier that's not a "provider of services" (typically a Part B provider or supplier) with fewer than 10 full-time equivalent employees.

    Generally, home health agencies will qualify for the 25 FTE exemption while durable medical equipment suppliers will fall under the 10 FTE exemption, notes attorney John Gilliland II with Indianapolis-based Gilliland & Caudill.

    Qualifying providers need take no action to preserve their status as paper billers, who therefore will sidestep the HIPAA transaction rule requirements. "If you believe that you meet the small provider exception, there is not a 'waiver' for you to sign," CMS says. "Just continue to bill via paper."

    But Gilliland and HIPAA expert Gene Tischer with the Associated Home Health Industries of Florida don't expect many home care providers to use this exemption.

     

    "I would not recommend any HHA to take this delay," says one expert.

     

    First, it's an exemption from filing electronically according to HIPAA standards, not immunity from the HIPAA privacy rule, Gilliland stresses. "Quite a few providers ... think they are not covered by the privacy rule because they have fewer than 25 or 10 employees," Gilliland notes. That common HIPAA myth "is not correct."

    Second, providers already billing electronically would see major cash flow delays if they go back to paper billing. Paper claims have a 28-day payment floor while electronic claims have only a 14-day wait. That's if paper claims are paid promptly, "which I doubt they will be," Tischer says.

    And CMS has promised no timeframe for the exemption, Tischer points out. CMS officials may say it's OK to bill via paper in October and change their minds in November.

    Finally, many HHAs simply won't qualify for the exemption due to the 25 FTE limit, Gilliland says. DME suppliers may have more luck fitting in under their 10 FTE cap.

    "I don't see any 'small' HHAs going back to paper to avoid HIPAA," Tischer expects. "I would not recommend any HHA to take this delay."

    Most home care providers will look to their software vendors to ensure HIPAA transaction standard compliance, Gilliland notes. Unfortunately, many HHAs' vendors have been suspiciously quiet about HIPAA.

    "Agencies should ask their software vendors how the vendor is doing in achieving compliance with the transaction standard deadline," Gilliland advises.

    All Medicare contractors are ready for HIPAA testing, CMS says.

    Editor's Note: The notice is at www.cms.hhs.gov/hipaa/hipaa2/Smallproviderwaiverltr06-24-03.doc. For more HIPAA information, see Eli's Health Information Compliance Alert and Eli's HIPAA Training Alert at www.eliresearch.com.

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