Group bristles at CMS' edict on non-compliance

By Healthcare IT News
12:00 AM

A group of healthcare organizations is waiting to hear whether the Centers for Medicare and Medicaid Services will respond to its letter, protesting its plans to enforce HIPAA data content requirements.

The HIPAA Implementation Working Group asked CMS Administrator Mark McClellan to reconsider plans to ratchet up enforcement of claims requirements.CMS has instructed carriers and fiscal intermediaries to reject Medicare claims that are missing data elements that enable the agency to forward "crossover claims" to other payers that are responsible for paying part of a beneficiary's bill.

The working group's letter said the move would increase the data collection burden and financial risk for providers.

"The concern is whether or not these new edits will be something that providers will be able to do as quickly as CMS thinks they will be able to do," said Lawrence Hughes, regulatory counsel for the American Hospital Association, a member of the group.

The group is asking CMS to back off on its instructions to reject claims and to take steps to accelerate implementation of standardized HIPAA transactions that will help providers achieve savings.

Members of the group include the AHA, American Medical Association, Association for Electronic Healthcare Trans-actions, Laboratory Corp. of America Holdings and WebMD.

"CMS needs to step up to figure out ways to address systemic problems," Hughes said. "It could be an authoritative voice that could give direction about questions or related to the standards."

CMS was to implement a set of standardized transactions last October. However, at the urging of several groups, it delayed implementation and put a contingency plan into effect.

Under that plan, Medicare continues to accept noncompliant claims transactions.

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