The CMS instructed Medicare fiscal intermediaries that as of July 1, they should delay payment of electronically submitted medical claims at least 27 days if the claims are not compliant with transaction standards required by HIPAA. Normally electronic claims are paid after 14 days. The upshot is the CMS will be treating noncompliant claims the same way it treats paper claims, said Lawrence Hughes, the American Hospital Association's regulatory counsel. In a letter to its Medicare fiscal intermediaries dated Feb. 27, the CMS said the move was to encourage its trading partners-providers, clearinghouses and healthcare information technology vendors-to comply with HIPAA standards as soon as possible. The federal government in September 2003 said it would institute a contingency plan to give trading partners an unspecified amount of time past the regulatory deadline of Oct. 16, 2003, to work out problems encountered when trying to send claims under the new standard formats.
Anthem merger clears review
The Federal Trade Commission and the U.S. Justice Department approved the proposed $16.4 billion merger of Anthem, Indianapolis, and WellPoint Health Networks, Thousand Oaks, Calif. The action eliminates one of the biggest hurdles for the two for-profit insurers, which together would have $27 billion in assets and cover 26 million members through Blue Cross and Blue Shield plans in 13 states. Providers and consumer groups have expressed concern that the merger of the nation's two largest Blues insurers would result in serious antitrust issues. The deal, announced in October 2003, still requires approval from state regulators, both companies' shareholders and the Blue Cross and Blue Shield Association.
Quality measures proposed
The National Committee for Quality Assurance proposed five new measures of health plan performance that assess quality of care and physician advice on common health issues, such as back pain and post-heart attack care. To make way for the new measures, the NCQA also proposed retiring five measures used since the mid-1990s in its Health Plan Employer Data and Information Set. New measures include the persistence of clinicians in providing beta blocker treatment after a heart attack; use of imaging studies in low back pain; drug therapy in rheumatoid arthritis; and for older adults, advice on physical activity, as well as prevalence of screening for glaucoma. Comments can be e-mailed to [email protected]