CMS gives HIPAA-covered entities more time to meet claims standards compliance

HIPAA-covered entities will have an extra 90 days to comply with rules for electronically checking eligibility for health plan coverage and the status of healthcare claims, the Centers for Medicare & Medicaid Services' Office of E-Health Standards and Services announced this week.

Initially, entities--including health plans, healthcare providers and clearinghouses--were required to meet such eligibility by Jan. 1, 2013. OESS delayed the enforcement due to "industry feedback" suggesting that most entities would not be able to meet that deadline.

"To reduce the potential of significant disruption to the healthcare industry," OESS now will not take enforcement action on non-compliant entities until March 31.

"This enforcement discretion period does not prevent applicable HIPAA-covered entities that are prepared to conduct transactions using the adopted operating rules from doing so," CMS said in its announcement.  "[A]ll applicable covered entities are encouraged to determine their readiness to use the operating rules as of Jan. 1, 2013 and expeditiously become compliant."

CMS warned, however, that OESS still will accept complaints associated with compliance starting this month. To that end, filed-against entities--organizations that are the subject of complaints--will be required to produce proof that they either are compliant or are in the process of trying to become compliant with the rules within the 90-day period.

The U.S. Department of Health & Human Services initially published the interim final rule for those operating rules in July 2011, with a goal of reducing excessive administrative work in physician practices. That rule was made final in December 2011.

To learn more:
- here's the CMS announcement (.pdf)


Fuel Top Line Growth and Increase Membership

In this webinar, payers can learn how to accelerate the sales pipeline and grow membership across all health insurance market segments using comprehensive sales technologies.