HIPAA regulations may be hit by a variety of delays

By Healthcare IT News
12:00 AM

Remaining HIPAA regulations will be getting a slow and careful look from federal rule-makers, who suddenly have a full plate of things to do.

Meanwhile, there's no certainty how long the government will delay enforcement of the HIPAA transaction and code set rule, although a national organization is expected to find evidence that the grace period that started in the fall should continue.

In late January, the Centers for Medicare and Medicaid Services announced the adoption of the national provider identifier as the standard unique identifier for healthcare providers. Providers can use the number for filing healthcare claims and other forms of electronic transactions.

The provider identifier will be a new number to be issued through the National Provider System, being developed by CMS, and which will replace all "legacy" numbers currently in use.

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The rule goes into effect on May 23, 2005, which is when providers can apply for their numbers. The new numbers must be used by May 23, 2007, with a one-year delay for small health plans.

It's uncertain if the new system will enable providers' locations to be identified, said Gary Kurtz, associate vice president for information services at Geisinger Health System, a Danville, Penn.-based healthcare system.

CMS will need to produce an estimated 1 million numbers for provider identifiers, said Steven Lazarus, president of Boundary Information Group, a Denver-based consulting firm specializing in HIPAA.


The provider identifier announcement was expected in December, and the delay suggests that CMS has its hands full with recent legislation and remaining contentious issues, Lazarus said. Staff involved in developing HIPAA regulations also picked up responsibilities under the recently passed Medicare reform bill.

The federal office hasn't indicated when it would publish the first version of the national health plan identifier, he noted. There's still a lot of mystery surrounding the eventual approach that CMS will use with it, and the biggest uncertainty is whether large multi-state health payers will be identified with a single number or whether each entity within them will have separate numbers.

There's still no indication of when CMS will end the grace period for enforcing the transactions and code set rule, which was delayed in October when it became apparent that providers and payers weren't ready to make the switch.


In late January, the Workgroup for Electronic Data Interchange met to take written and oral testimony on the industry's transition to HIPAA-compliant formats. It planned to take that testimony and make a recommendation to the HHS secretary on the industry's progress, Lazarus said.

Currently, the percentage of HIPAA-compliant transactions received by Medicare appears to be rising very slowly.

In late January, the agency reported that 57.6 percent of claims received from Jan. 5 through Jan. 9 were compliant. In mid-December, that percentage stood at 55.5 percent, said Donald Masser, a technical analyst with the information technology department at Geisinger.

"We'll probably have to get to the 75 percent to 80 percent threshold before CMS announces that there's going to be a deadline for completing the transition process," Lazarus said.

In December, CMS sent out a memorandum to its contractors and intermediaries asking them to speed the conversion and to work with submitters and providers to identify a plan for conversion "in a reasonable time period."

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