One might get the sense that doctors are being led to an execution, the way so many healthcare entities are begging for leniency in the final days before the Oct. 16 deadline to implement HIPAA regulations for electronic transactions and code sets.
They are, after all, trying to avoid a form of capital punishment--a potentially fatal cash-flow slowdown.
What passes for a reprieve came Sept. 23, when CMS announced it would continue to accept electronic claims in noncompliant HCFA 1500 and UB92 formats for an unspecified time after the deadline, "after reviewing statistics showing unacceptably low numbers of compliant claims being submitted."
CMS says only about 14% of the Medicare claims it was receiving in late September were in the HIPAA-mandated X12 837 code set, though that figure is up from 12% in August.
At press time, commercial payers were expected to follow the CMS lead, as healthcare providers, transaction software vendors and clearinghouses had been calling for.
What CMS does not do is back away from an earlier pronouncement that it will no longer pay Medicare claims submitted on paper beginning Oct. 16, except from very small practices and in a few other limited circumstances. A public comment period on that rule runs until Oct. 14.
CMS, the agency in charge of HIPAA transaction enforcement, says, however, that it will not punish providers for missing some data elements of HIPAA standard transactions if they can demonstrate good faith in working toward compliance.
Clearinghouses clearly are playing a major role in the last-minute scramble before the official deadline, but they, too, are only as good as the data elements they receive.
"If the provider has not captured them, the clearinghouses cannot make them up," says Steven Lazarus, a healthcare information technology consultant in Denver.
Additionally, medical practices that have been sitting idly by should not expect clearinghouses to bail them out, says Brian Gallagher, vice president of risk management and governance at NDCHealth, an Atlanta-based company that runs one of the nation's largest healthcare clearinghouse operations.
"One of the things we're trying to emphasize is that you can't come to us on Oct. 15 and say, 'Hey, we're ready to test,"' Gallagher says.
Lazarus adds, "No one should feel comfortable, if their trading partner is taking their nonperfect transactions, that they will continue to do so for very long."
In other words, any reprieve will be a short one.