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.