Extension Granted For Electronic Medicare Filing

Physicians who bill Medicare electronically for their services have another year to ensure that their electronic-billing information meets the requirements of a 2000 federal rule. The deadline for complying with the new requirements as set out in legislation recently signed by President Bush is now October 16, 2003. The only catch is that clinicians must request the extension in writing by October 15, 2002.

Sen. Larry Craig (R-Idaho), who cosponsored the legislation granting the one-year extension, told his colleagues in last October that “it provides a much-needed additional year for clinicians, state health programs, health plans, and others to implement the transactions and code-set provisions of administrative simplification. Importantly, this new version also includes language to differentiate between this provision and the privacy provision of HIPAA” (Health Insurance Portability and Accountability Act).

The new law grants an exemption to health care professionals who have fewer than 10 employees and those who do not have access to electronic methods of transmitting claims. Those who believe they qualify for the exemption, however, must still respond in writing to the federal Centers for Medicare and Medicaid Services (CMS) by the October 16 deadline.

In the 1996 HIPAA law, Congress mandated that Medicare and Medicaid simplify their administrative procedures to make the payment system more efficient and less costly. This included developing uniform standards for electronic transactions and billing codes.

“Transactions” are defined in HIPAA as “electronic transmission of information between two parties to carry out financial or administrative activities related to health care,” according to CMS.

The term “code sets” refers to ICD-9 diagnostic codes and the CPT procedure codes, according to CMS.

The HIPAA standards developed by CMS cover health care claims, status, payment, and remittance advice; coordination of benefits; enrollment and disenrollment in a health plan; health-plan eligibility and premium payments; and referral certification and authorization. The standards for the first report of injury and health-claim attachments will be adopted at a later date.

As the Craig legislation moved through Congress, APA advocated that the bill’s cosponsors not be allowed to tamper with the implementation of the medical privacy rule, which takes place in April 2003 (Psychiatric News, March 1).

“It was our intention all along that the medical privacy regulations not be affected by our legislation, and we believe this bill accomplishes that goal,” said Craig.

APA also was pleased with the provisions that exempt from the compliance deadline those health care professionals who do not have access to electronic methods for submitting claims and those who have fewer than 10 full-time-equivalent employees, said Nancy Trenti, an associate director of APA’s Division of Government Relations.

To be granted an extension, clinicians may want to visit the CMS Web site, where a model form on how to request the extension should be posted by March 31, according to Stanley Nachimson, senior technical advisor of the CMS Office of Information Services.

“We hope to make the form as easy to complete as possible so that providers, health plans, and clearinghouses can send us the required information such as their budget, schedule for HIPAA implementation, work plan, and implementation strategy for achieving compliance,” said Nachimson at a CMS meeting on HIPAA in January.

The model form should also address the following according to the 2001 law:

• An analysis reflecting the extent to which and the reasons why the person or entity is not in compliance.

• Whether the person or entity plans to use or might use a contractor or vendor to assist in achieving compliance.

• A timeframe for testing that begins no later than April 16, 2003.

Nachimson said that CMS will also be issuing further guidance on how providers can implement the new provisions and whether they qualify for the exclusions.

The CMS Medicare Learning Network is the likely place for CMS to post its model form. Its Web page is www.hcfa.gov/medlearn/default.htm. The CMS Medicare Electronic Data Interchange Web page at www.hcfa.gov/medicare/edi/edi.htm provides links to more Internet resources on HIPAA’s administrative simplification standards for electronic transactions and codes. The text of the Administrative Simplification Compliance Act (HR 3323; also Public Law 107-105) can be accessed on the Web at http://thomas.loc.gov/ by clicking on “Public Laws by Law Number” and then “107-101–107-146” and scrolling down to “105.” ▪