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AHA urges CMS to provide more transactions guidance

HIPAA Weekly Advisor, September 28, 2003

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The Centers for Medicare and Medicaid Services (CMS) addressed the enforcement aspects of transactions and codes sets compliance in its July 24 guidance on the subject, but failed to address several important issues, according to the American Hospital Association (AHA). CMS' failure to act decisively on these issues will only prolong confusion and difficulty and increase the possibility of large-scale payment disruptions, the AHA told the National Committee on Vital and Health Statistics in an August 21 statement.

Covered entities still need guidance on contingency planning, including specific actions to lessen disruptions to the payment cycle, George Arges told the committee on behalf of the AHA. Arges is senior director of the association's health data management group. CMS also needs to address whether otherwise compliant claims that contain missing or incorrectly reported non-material data elements can be processed by a health plan without fear of being cited for a violation, he added.

"Between now and October 16, it is important for all covered entities to understand what specific actions demonstrate their good faith efforts to implement the standards," said Arges. "The CMS guidance encourages health plans to begin testing the transactions with providers in order to demonstrate their good faith efforts. The AHA, however, continues to hear from hospitals about their frustration at being unable to test with many health plans or the lateness of the testing schedules issued."

To read the statement, click here: http://www.hospitalconnect.com/aha/key_issues/hipaa/transactions/NCVHS082103.html

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