Revenue Cycle

CMS helps covered entities understand new HIPAA edit requirements

Patient Financial Services Weekly Advisor, May 21, 2004

Come July 1, your claims will be held to different requirements as specified by HIPAA. In an effort to head off confusion, CMS released an educational report about the changes required for your claims to be HIPAA compliant.

The report discusses the following new expectations in greater detail:

  • Medicare claims must include certain HIPAA-required data elements that were not previously conditions of Medicare claims adjudication
  • Claims including data prohibited by HIPAA will be rejected
  • Claim content formerly edited only for syntax will be examined for content now and could result in claim rejections

    To read the entire report, click here.

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