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CMS delays enforcing HIPAA claims standards


By Joseph Conn
Posted: January 4, 2013 - 10:15 am ET
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The CMS has rolled back by three months the date it will begin enforcing new standards that health plans, claims clearinghouses, providers and others must meet when checking insurance eligibility and the status of healthcare claims electronically.

In making the announcement, the CMS said that the Jan. 1, 2013 compliance deadline remains in place but that enforcement won't start until March 31. The rule affects hospitals, office-based physicians, health plans, claims clearinghouses and all other "covered entities" under the Health Insurance Portability and Accountability Act.

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"Industry feedback suggests that HIPAA covered entities have not reached a threshold whereby a majority of covered entities would be able to be in compliance with the operating rules by Jan. 1," according to a CMS statement. "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."

In fact, the CMS said "all applicable covered entities are encouraged to determine their readiness to use the operating rules" and "expeditiously become compliant." Although enforcement action will not be taken immediately, CMS' Office of E-Health Standards and Services "will accept complaints associated with compliance with the operating rules" as of Jan. 1, and if requested by the standards and services office, "covered entities that are the subject of complaints (known as "filed-against entities") must produce evidence of either compliance or a good-faith effort to become compliant with the operating rules during the 90-day period."

Links to information on the operating rules are available on CMS' website.


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