Only 6 months until next HIPAA hurdle

It may be too early to panic, but it's time to start getting ready for federal standards for electronic transactions.

By Joel B. Finkelstein, AMNews staff. April 21, 2003.

Washington -- Health plans and other payers that are having problems implementing new electronic transaction standards may pass those problems down the line to physicians.

Electronic transaction provisions of the Health Insurance Portability and Accountability Act require payers, clearinghouses and physician practices to conform to a national standard for maintaining and transmitting patient claims and other forms.

Physicians have until Oct. 16 to come into compliance with these standards. But the Dept. of Health and Human Services set April 16 as the deadline for clearinghouses and software vendors to begin testing their upgrades so that doctors, in turn, can make their deadline.

The types of electronic transmissions covered in the rule include claims (or encounter information), coordination of benefits, remittances, eligibility verification, pre-certification or authorization for referrals, and claims status inquiry.

"We believe the industry is making great strides in moving forward with implementation," said Edward D. Jones, chair of the Workgroup for Electronic Data Interchange, an organization created to foster the use of electronic transactions in the health care market.

The health care industry is large and complex. Along the path to compliance, doctors have multiple payers to deal with and vice versa, he said.

There is a lack of information about where physicians are in terms of getting ready for the deadline, said Carl Cunningham, director of the practice management center at the American College of Physicians. But an informal poll at a recent meeting suggests that about three-quarters of physicians have been at least asking vendors about readiness.