Ready Set Hold It!

How many times were we told that the Health Insurance Portability and Accountability Act (HIPAA) electronic transaction set would be implemented on Oct. 16, 2003? Well, in an effort to allow providers to turn the switch and bill the new ANSI format, it was found that many of our trading partners, for whatever reason, were not ready for the event. So, the Centers for Medicare and Medicaid Services has activated a contingency plan that grants an extension to that well-publicized deadline.

This does not mean that HIPAA is going away. Providers must show a good faith effort in complying with the new electronic guidelines for claims submission. Have you developed a plan? Is your software vendor ready? Are you electronically transmitting now under the ANSI format? Are you ready to deal with an interruption in cash flow due to transmission issues? If you answered “no” to any of these questions, you are not alone.

In speaking to providers across the nation, many who have begun transmitting under the ANSI format have not received payments from the DMERCs for one to two months. Your company should be prepared with a plan on how you are going to handle this cash flow problem. Do you have an adequate line of credit or cash reserves that will allow you to operate for 30 to 60 days? If not, you need to develop a relationship with your financial institution or investors to put such a plan in place.

Have you thought about staffing issues? You may need additional personnel on the telephones to resolve billing issues with various providers.

Identify your largest payers, and communicate with them about how they expect to reimburse you for your services in the event that you cannot transmit claims to them electronically. You may find that some of your trading partners are not ready, and that you need to adjust your business practices accordingly.

Have you begun testing with the DMERCs or other trading partners? If you have not yet tested, the time to do so is now. Call your software vendor to verify that they are certified with all four DMERCs, and find out if you need to update your software to become HIPAA-compliant. This could cost your company extra in support fees, but it may be a necessary expense in conducting business under the new HIPAA guidelines.