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GOVERNMENT & MEDICINEHIPAA scramble may delay Medicaid paySome states still trying to respond to the regulation are eyeing reserve funds, planning to accept noncompliant claims or turning to clearinghouses to make sure physicians get paid.By Joel B. Finkelstein, AMNews staff. Aug. 25, 2003. Washington -- Many state Medicaid programs are struggling with implementing new federal electronic transaction standards, and that could mean delayed physician reimbursement come the Oct. 16 compliance deadline. But states are trying to plan ahead to ensure payments continue to flow. New Mexico is one example. The state's Human Services Dept., which runs the Medicaid program, has spent more than $7 million, just since June, trying to prepare for implementation of the Health Insurance Portability and Accountability Act's electronic transaction rule. That's after spending $14 million the past couple of years updating its Medicaid claims processing system, only to find out that it would not be HIPAA compliant. As questions are being raised about accounting tactics that allowed the state to sign a contract with the system vendor without competitive bidding, New Mexico officials are starting to point fingers, and the state is expected to miss the compliance deadline. "If that is the case, I am concerned about delays in payment," said James Spence, MD, president of the New Mexico Medical Society. The society doesn't really care about who is to blame for missing the deadline, it just wants to make sure physicians will still get paid for providing services. Dr. Spence said the group is working with the state to set up a reserve fund, "something to tide us over until the state is HIPAA compliant." The cash reserve would allow the state to pay physicians and others based on historical reimbursement levels. Once the Medicaid program worked out its compliance problem, it could go back and process the claims that had been filed in the interim. [...]Full text of AMNews content is available to AMA members and paid subscribers.
Copyright 2003 American Medical Association. All rights reserved.
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