Medicare Compliance & Reimbursement

Will the feds act to avert a HIPAA "train wreck"?

Is anyone ready for the Oct. 16 Health Insurance Portability and Accountability Act transaction standard zero hour?

Even if providers are, their payers may not be - and a coalition of health care providers is calling for the Department of Health and Human Services to take action to forestall what it calls a looming cash flow "train wreck." HHS needs to act now "to prevent the breakdown of the fiscal and administrative infrastructure of the health care system that will occur as a result of an uncoordinated implementation of the HIPAA Transaction Rule," says the coalition - which includes the American Hospital Association, the American Medical Association and other groups.

In a July 1 letter, the groups urge HHS to establish a "reasonable migration period" starting Oct. 16 during which claims, to be considered HIPAA compliant, need only use the standard format, use the standard codes, and include only the data elements required for claims adjudication. They also say HHS needs to ensure that providers' cash flow isn't significantly disrupted and should order payers to perform transactions testing with any business partner that requests it.

The big question: Will HHS respond?

At least one insider thinks so. American Clinical Laboratory Association President Alan Mertz said the provider groups "were very encouraged by Secretary Thompson's response" to their letter. "He clearly understands the magnitude of the problem and wants to work with the provider and payer communities to fix it."

Lesson learned: Avoid a HIPAA transactions disaster by doing everything you can to perform testing with your payers in advance.