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October deadline for non-HIPAA compliant Medicare claims

Ambulatory Surgery Reimbursement Update, August 9, 2005

Beginning October 1, 2005, the Centers for Medicare & Medicaid Services (CMS) will not process incoming electronic Medicare claims submitted for payment that are not HIPAA-compliant, according to a press release from CMS.

If CMS receives a non-HIPAA-compliant claim from October 1 on, the claim will not be processed and will be returned to the filer for re-submission.

Only about 0.5% of Medicare fee-for-service providers submitted non-HIPAA-compliant electronic claims as of June 2005, leading CMS to believe that everyone can submit compliant claims.

"We are firmly committed to an interoperable electronic health care system, and the close-to-100% compliance with HIPAA standards for claims shows that the health care industry shares this commitment," said Mark McClellan, MD, CMS administrator.

"We'll be working with the non-compliant providers between now and October 1 with the goal of getting as close to 100% as possible before then," he said.

To read a CMS article with information for providers on the termination of the HIPAA contingency plan for incoming Medicare claims, click here.

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