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CMS: It’s the HIPAA way or the highway

Case Management Weekly, August 10, 2005

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The Centers for Medicare & Medicaid Services announced last week that it will no longer process electronic Medicare claims that are not in compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA). According to the agency, beginning October 1, filers of electronic claims not formatted in a HIPAA-compliant manner can expect to have them returned for resubmission. CMS' plan to move providers to the HIPAA-compliant process for electronic claim submission affects only services provided under fee-for-service Medicare; however, the agency's plan to make other electronic healthcare transactions HIPAA-compliant is expected to branch out even further, next tackling the remittance advice transaction. The agency reported clinical laboratories as having the highest rate of noncompliance (1.72%), and said that most hospitals-at only 1.45 %-were in compliance with the HIPAA electronic Medicare claims process.

Source: CMS' Web site

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