The Medical Group Management Association is leading a coalition of about 40 medical organizations in asking HHS Secretary Tommy Thompson for leniency on an upcoming HIPAA deadline that could prevent doctors from getting paid.
With the Oct. 16 compliance deadline for the HIPAA electronic transaction and code set standards less than four months away, the Englewood, Colo.-based MGMA, along with the AMA, the American College of Physicians and numerous other physician groups, proposed three contingency plans in a letter sent to the secretary on June 30.
"While physicians and other providers have been actively engaged in their implementation efforts, it remains doubtful that all covered entities will be fully compliant in time to meet the deadline," the letter says. "The possible rejection of non-standard electronic transactions and the resulting reversion to paper transactions could result in a major disruption of payment flows to providers under Medicare, Medicaid and private sector health plans."
The physicians say they have depended on their trading partners, some of which are not covered entities, to assist them with compliance efforts. Many of those vendors have failed to provide compliant software upgrades that can be tested and implemented in time, doctors say.
"Physicians medical group practices and others have relied heavily on health plans and billing software vendors and clearinghouses for compliance assistance," says MGMA President and CEO William Jessee, M.D., in a written statement. "In many cases, these providers have not provided the necessary resources to meet the Oct. 16 deadline."
"Medical group practices are concerned that delayed claims payment could cause interruptions of patient care and potential for economic failure for organizations," Jessee says.
The three recommended contingency plans are:
- Permit health plans to accept HIPAA standard claims transactions that may not contain all the required data if these can otherwise be processed by the plan.
- Allow a compliant covered entity to continue accepting nonstandard transactions for a brief period, thereby giving providers time to complete their software upgrades and systems testing.
- Provide an incentive to noncompliant health plans to offer interim payment to their provider clients.
To remove the uncertainty heath plans have about what enforcement action could be taken if they process nonstandard claims, the physicians say HHS should issue guidance that paying such claims will not cause an otherwise compliant health plan to be considered noncompliant.
HHS also should encourage health plans to give providers specific testing dates and procedures to send test transactions, the doctors say. Without the ability to test, providers cannot determine which data elements are required by each plan.
"With a rapidly approaching deadline, we encourage HHS to approve and announce policies permitting operational compliance flexibility to avoid a potentially catastrophic disruption of the payment cycle," Jessee says.