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HIPAA deadline is here
Must You Submit Medicare Claims Electronically? | |
Q: | Will you be required to submit Medicare claims electronically after Oct. 16? |
A: | Yes, you will be required to submit your claims to Medicare electronically if you have 10 or more full-time equivalent (FTE) employees in your practice. No, if you have fewer than 10 FTE employees. Yes, if in the future your total FTE employees surpasses 10. |
Q: | Must you comply with the electronic standards of HIPAA? |
A: | Yes, you must comply if you have more than 10 FTE employees. Yes, if you have fewer than 10 employees but are voluntarily submitting claims electronically to Medicare. |
Are you confused or frustrated by conflicting answers to what seem to be vital questions? Ever feel like the penalties are more clearly defined than the rules? Well, join the club. We’re talking about life in the world of third-party programs, especially governmental third-party programs.
The latest confusion is over the requirement that providers comply with the electronic data interchange (EDI) standards of the Health Insurance Portability and Accountability Act (HIPAA) of 1996. Most health care providers will remember applying for an extension on last October’s deadline, allowing them to wait until Oct. 16, 2003, to comply.
None of us was ready to comply a year ago, because we didn’t know what the standards were. Few of us are ready to comply now, but the deadline is very near and it is very clear that there will be no further extensions.
If you are submitting claims electronically, it is important that you do what you can to be sure that those submissions are compliant with the HIPAA standards.
Here’s what you can do:
- If you submit claims through your own computers, via proprietary software or through your office management software, you should contact the software vendor(s) and ask for their assurance that the software and the submissions of claims are HIPAA compliant.
- If you submit claims through a clearinghouse or through a Web site, you should contact the responsible parties to acquire their assurance that the submissions are HIPAA compliant.
- In some cases, the vendors will contact you proactively, to avoid having to deal with inquiries from all their clients. In either case, be sure to get a written record of the assurance from the responsible parties and include that information in the HIPAA compliance materials for your office.
Please keep in mind that this article is written based upon information available on Sept. 8. Be sure to watch the professional press continuously for updates and corrections.