Corporate Compliance

CMS: Electronic claims must meet HIPAA standards

Compliance Monitor, August 10, 2005

Healthcare providers must meet yet another aspect of the Health Insurance Portability and Accountability Act (HIPAA) beginning this fall.

On Oct. 1, the Centers for Medicare & Medicaid Services (CMS) will begin to return electronic claims that do not meet HIPAA standards. Until that date, noncompliant claims will be processed.

As of June, only about 0.5 % of Medicare fee-for-services providers submitted noncompliant electronic claims, according to a CMS release. The highest rate of noncompliant claims as of May was from clinical laboratories at 1.72%. Only 1.45% of claims from hospitals were noncompliant, as were about 0.45% of claims from physicians.

"We are firmly committed to an interoperable electronic healthcare system, and the close-to-100% compliance with HIPAA standards for claims shows that the healthcare industry shares this commitment," says CMS Administrator Mark B. McClellan.

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