December 2003 News Archives

December 29, 2003 CMS Tells Contractors to Speed TCS Conversion On November 25, 2003, the Centers for Medicare & Medicaid Services (CMS) sent out a Joint Signature Memorandum (JSM) which told CMS contractors and fiscal intermediaries to speed the conversion to standard transactions and the potential impact this might have on healthcare providers who utilize a clearinghouse for submitting Medicare claims. While the volume of Medicare electronic claims received in the HIPAA format has increased from 48.44% for the period of Nov. 10-14, it has only reached 55.48% as of Dec. 15-19.

According to the Atlanta CMS Regional Office, CMS issued a clarification on December 12 to its contractors that they should work with submitters and providers to identify a plan for conversion in a reasonable time period. The following guidance clarifying the JSM was sent to CMS' systems specialists who work with Medicare contractors:

"CMS is trying to end its contingency plan for HIPAA as soon as feasible. It appears that there are a number of submitters that have been approved for production but have not moved many of their production claims into the HIPAA format. In order to accelerate this movement, CMS directed contractors via the Nov. 25 JSM to work with these submitters to move their full workload into production within 30 days. This note is to amplify on that directive. The 30-day requirement is not an absolute deadline. Contractors cannot unilaterally deny these submitter legacy formatted claims. They must use this new tool from CMS to initiate discussions with individual submitters (clearinghouses, vendors, individual large providers) in this situation. They need to develop a plan with the submitter to move all their claims into production. This can be for a period longer than 30 days if a clear path to compliance is discernible in a reasonable period. If a submitter cannot work out an acceptable plan with the contractor, the contractor should discuss the particulars of the situation with CCMS. If the submitter represents a significant claims volume for the contractor, the contractor may arrange for a three-way discussion (submitter, contractor, CCMS) to further pursue discussions toward achieving an acceptable transition plan."

December 23, 2003 HHS Updates Status of HIPAA Rules in Semiannual Agenda Yesterday's Federal Register contained the Unified Agenda (also known as the Semiannual Regulatory Agenda), summarizing the rules and proposed rules that each Federal agency expects to issue during the next six months. The Department of Health and Human Services expects the following in regards to HIPAA:

• The Standard Unique Health Care Provider Identifier Final Rule is still set to be published this month.
• The estimated publication date for the Claims Attachments Standards Proposed Rule has been changed from January to August 2004.
• The Standard Unique National Health Plan (Payer) Identifiers Proposed Rule was expected to be published by the end of this year; the date is now yet to be determined.
• The Electronic Medicare Claims Submission Final Rule is estimated to be published in September 2004, replacing the interim final rule issued August 15 of this year.

Keep up-to-date with the status of the HIPAA regs with our Compliance Calendar.

December 23, 2003 Group Seeks Industry Input on Model Electronic Health Record The EHR Collaborative, a group of organizations representing key stakeholders in healthcare, will be conducting a series of meetings to gather feedback on the latest draft model for an electronic health record (EHR). An open informational audio session will be presented at 2 PM EST on both January 5 and 6. Representatives from the EHR Collaborative will present a draft of the functional model to help providers of all disciplines and care settings understand the model and standard. A series of four conference calls will follow during which input and feedback on the model will be gathered. Conference calls will be held at 2 PM EST for the following care settings:

• January 8: Care in the community
• January 13: Hospital
• January 14: Ambulatory
• January 16: Nursing homes

Individuals interested in providing feedback should participate in one of the audio sessions as well as the appropriate conference call for their care setting. Those interested in participating can register by sending an email to: info@ahima.org with the words “EHR Audio Seminars” in the subject line and the requested audio session, date, and care setting listed in the body of the email.

The EHR Collaborative will also hold four feedback sessions February 23 – 26 with key industry groups at the Healthcare Information and Management Systems Society (HIMSS) Annual Conference in Orlando, FL.

December 22, 2003 OCR: HIPAA Does Not Prohibit Holiday Carolers Responding to the Dec. 18 Wisconsin State Journal article, "HIPAA Gives 'Silent Night' New Meaning," Richard Campanelli, Director of the Department of Health and Human Services' Office for Civil Rights (OCR), wrote, "we are happy to confirm in this holiday season that HIPAA does not prohibit carolers in hospitals." The HIPAA Privacy Rule, which OCR is charged to enforce, simply requires that hospitals take reasonable steps to protect patient information. "(H)ospitals can have policies that allow carolers and other visitors, but are also sensitive to patient privacy. Patients enjoy caroling, and patients deserve privacy. This holiday season, they can have both," said Campanelli.

Read more.

December 12, 2003 AHA Voices Concerns on Claims Handling Under HIPAA At a HIPAA forum in San Diego this week, an American Hospital Association (AHA) official said that because interpretations can differ markedly over how to implement the HIPAA transaction standards, health plans are being arbitrary and inconsistent when they spot "imperfections" in claims filed under the new standards. George Arges, Senior Director of AHA's Health Data Management Group, said it's unreasonable, for example, for insurers to reject a batch of up to 100,000 claims when there's an error in just one of those filings. Speaking at that same forum, a regional manager with HHS' Office for Civil Rights (OCR) said that roughly 3,400 privacy complaints have been filed with OCR since mid-April.

Also this week, AHA sent a letter to the National Committee on Vital and Health Statistics (NCVHS) on the proposed rule on claims attachments, which has an estimated publication date of sometime next month. According to the letter, the claims attachment rule is expected to contribute significantly to the operational efficiencies and costs savings of administrative simplification; and, as a result, the AHA for some time has been urging expedited release of the claim attachments proposed rule. AHA's letter urges the committee to recommend that the Centers for Medicare and Medicaid Services' (CMS) adopt their suggestions so that the claims attachment standard "does not become another means to delay processing of claims by health plans and thereby add unnecessary administrative costs to the system."

Read more.

Read AHA's letter to NCVHS (document file).

December 2, 2003 Report Calls for National Patient ID Standard A new report by the Institute of Medicine of the National Academies calls for healthcare organizations to adopt IT systems that are capable of collecting and sharing patient health information. These systems should operate seamlessly as part of a national health information infrastructure that includes secure electronic health records and uniform data standards, said the committee that wrote the report. The report outlines a plan to accelerate the development of data standards in three key areas: clinical terminologies, exchange of data among computers, and representation of medical information in computer programs.

According to Health Data Management, one of the data standards being called for in the report is a national patient identification system. "While not a data standard in the traditional sense, being able to link a patient's healthcare data from one departmental location or site to another unambiguously is important for maintaining the integrity of patient data and delivering safe care. Now that the HIPAA privacy rule has been implemented nationwide, means to link patient data across organizations should be revisited."

Read more.

December 1, 2003 Medicare Posts Lists of Top 10 Submitter Testing Problems & New Required HIPAA Data Elements The Centers for Medicare and Medicaid Services has posted new information regarding Medicare TCS compliance. A graph on the site shows that from November 10 to 14, the volume of Medicare electronic claims received in the HIPAA format was 48.44%. A Top 10 list offers guidance in response to submitter claim testing problems. The list covers technical and non-technical issues Medicare contractors have encountered that are preventing submitters from moving into production on the 837 claim. A second list covers the new required data elements on the HIPAA X12N 837 institutional and professional healthcare claim forms which were not previously required on the electronic Part A (UB92) formats and Medicare Part B (National Standard Format). As of October 1, all CMS transmittals are no longer broken into groups such as Part A, Carrier, etc.

Read the Top 10 CMS HIPAA Submitter Testing Problems (PDF).

Read the List of New Required HIPAA Medicare Data Elements (PDF).