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CMS encourages use of HIPAA-compliant electronic claims

Compliance Monitor, July 7, 2004

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As of July 1, electronic Medicare claims that do not meet Health Insurance Portability and Accountability Act of 1996 (HIPAA) standards will be treated as paper claims and paid more slowly than HIPAA-compliant electronic claims, said CMS Administrator Mark B. McClellan, MD, PhD.

"The great majority of electronic claims we are receiving meet the required HIPAA standards," McClellan said in a June 30 CMS release, "but for those still not in compliance there is going to be a delay in getting their money. We are hoping this will motivate more filers to get into compliance soon."

Noncompliant electronic claims will still be accepted by Medicare, but their payment will take 13 additional days, according to CMS, which announced a modification to its HIPAA contingency plan in February.

The modification had an effective date of July 1, but CMS said it will begin delaying payments for noncompliant claims submitted on and after July 6.

"By working collaboratively with healthcare providers on the use of standard electronic claims, we've been able to reach 90% compliance," McClellan said. "Now, a two-week payment delay is an important further incentive to get to 100%."

To read the release from CMS, click here.

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