Practice Management Alert

Here's what you need to know about the electronic filing final rule.

Good news: You've been given a reprieve on the Health Insurance Portability and Accountability Act's transaction standards rule. That means you don't have to submit all your claims electronically by Oct. 16, as orig-inally planned ... but you should still be moving quickly in that direction, because no one knows how long the reprieve will last.
 
CMS Sept. 23 conceded that too many providers aren't ready to submit HIPAA-compliant claims to enforce the rule with an iron fist on Oct. 16. The agency says it will implement a contingency plan to accept noncompliant electronic claims for an as-yet undetermined period after the HIPAA transactions rule deadline.
 
"Implementing this contingency plan moves us toward the dual goals of achieving HIPAA compliance while not disrupting providers' cash flow and operations," says CMS Administrator Tom Scully.
 
CMS says the contingency plan will give physicians and other providers more time to complete the testing process, and that the agency will "regularly reassess the readiness of its trading partners to determine how long the contingency plan will remain in effect."
 
The big question now: Will other payers follow suit? "We encourage other plans to assess the readiness of their trading partners and implement contingency plans if appropriate," says Tom Grissom, director of CMS' Center for Medicare Management.
 
At least one health plan, BlueCross BlueShield of South Carolina, says it "temporarily will continue to accept electronic transactions from current submitters in HCFA 1500s (private practice) and UB92 (hospital) formats after the Oct. 16 deadline."
 
"BlueCross is prepared for HIPAA, but our assessment ... indicates that it is necessary for us to adopt a contingency plan to prevent the possible disruption of cash flow" to providers, David Boucher, BlueCross' assistant vice president of health care services, says in a statement. "Of the 9,000 providers, fewer than five percent have tested with us for HIPAA readiness and even fewer have been successful," Boucher adds. Contingency Plan Is Not Cause To Snooze Despite the delay, experts advise providers to act quickly to get their houses in order, since the contingency plan won't remain in effect forever. Once implemented, the interim final rule CMS published in in the Federal Register Aug. 15 formally requires that Medicare and Medicaid claims be submitted electronically, with only a handful of exceptions. The biggest exception is small providers and suppliers. CMS defines "small" entities as either a) a provider of services with fewer than 25 full-time equivalent employees, or b) a physician, practitioner, facility or supplier with fewer than 10 full-time employees.
 
The rest of the exceptions include:
   circumstances in which there is no method available for the submission of an electronic claim - claims submitted directly [...]