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PRACTICE BULLETIN
Medicare Ends Contingency Plan for Non-HIPAA
Compliant Reimbursement Claims
Mirean Coleman, MSW, LICSW, CT
Senior
Policy Associate
August 12, 2005
Effective October 1, 2005 , Medicare will not process electronic
claims submitted for payment that are not HIPAA compliant. Electronic
claims that do not meet the electronic format will be automatically
rejected and returned to the clinical social worker. This does not
pertain to paper files.
Background Information
The Health Insurance Portability and Accountability Act of 1996
(HIPAA) required claims to be submitted electronically beginning
October 16, 2003 , using the electronic transaction standards. Since
69 percent of Medicare claims were non-compliant prior to that time,
the Centers for Medicare and Medicaid Services (CMS) established
a contingency plan on July 24, 2003 , allowing additional time for
clinical social workers and other providers to comply. Clinical social
workers who are Medicare providers in a small practice of 10 or less
providers were provided the option of continuing to file paper claims
by mail.
Recommended Actions
In preparing for the end of the Medicare contingency plan, social
workers should consider these suggestions:
- Use only HIPAA compliant software when filing a claim for reimbursement
with Medicare. CMS makes available for clinical social workers
free or low-cost billing software that can be obtained by contacting
your local Medicare carrier.
- Comply with the HIPAA electronic standards.
Doing so will prevent claim rejections and interrupted cash flow
problems in settings such as private practices, primary care
settings, and agencies.
- Be familiar with similar contingency plans
that other third-party payers may have also established. Contact
those with whom you have contracts to learn when they may end
their plans.
Resources
-
- Centers for Medicare and Medicaid Services. (2005). Medicareannounces
end ofHIPAA contingency plan for claims submissions [Online]. Available
at: Http://www.cms.hhs.gov/medlearn/matters/mmarticles/2005/MM3956.pdf
- NASW Legal Defense Fund. (2003). HIPAA desk reference. Washington
, DC : NASW Press.
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