American College of Physicians: Internal Medicine — Doctors for Adults ®

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ACP calls for flexibility in upcoming HIPAA deadline

From the July-August ACP Observer, copyright 2003 by the American College of Physicians.

ACP is calling for flexibility in implementing a HIPAA deadline that could affect physicians' reimbursement.

The next HIPAA regulation, known as the transactions and code sets rule, requires physicians to use certain standards when electronically transmitting health care information like claims and remittances. If physicians' office systems don't meet these standards by Oct. 16, insurers and other payers, including Medicare, may reject their claims.

In May 20 testimony before the National Committee on Vital and Health Statistics (NCVHS), the College urged the federal government to give payers flexibility in paying electronic claims after the deadline. The recommendation is designed to give practices time to finish testing and implementing the standards.

The College voiced its support for two proposals originally made by the Workgroup for Electronic Data Interchange, an industry organization. First, ACP said that payers should be able to continue to pay for transactions that use the new format required by the rule but are missing certain data required under the standard.

Second, ACP said that regulators should give health care organizations a short transition period during which they can process claims that don't meet the standards. Practices or other organizations that had done nothing to prepare for the new rule would not be able to take advantage of the transition period.

As a result of the meeting, the NCVHS plans to recommend that HHS create a short transition period during which health insurers could pay claims filed using the old format-as long as those health care providers were testing transactions using the new standard.

ACP's testimony is online.

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