How to Report HIPAA-Related Payment Hassles
[Posted 10/30/03]

Physicians having trouble with health plans, clearinghouses, or others who are not yet in compliance with HIPAA’s transactions and code sets rule can file an anonymous complaint through AMA’s online HIPAA Complaint Form. AMA will compile the data and share the results with the Centers for Medicare & Medicaid Services (CMS), the agency in charge of HIPAA enforcement.

Although physicians may also file complaints directly with CMS, CMA encourages members to use AMA’s complaint form so that AMA and CMA can monitor HIPAA compliance trends and develop tools to assist physicians.

As you know, the deadline for compliance with HIPAA’s electronic transactions rule was October 16. CMS has said it would be lenient with enforcement for a short time after the deadline, provided entities are making “good-faith” efforts at compliance and can demonstrate that noncompliance is temporary and designed to ensure claims processing and payments are not disrupted.

While these contingency plans allow health plans to continue to accept noncompliant electronic transactions, physicians cannot relax their compliance efforts. It is not clear how long these contingency plans will remain in effect.

Physicians who are not yet compliant are still advised to test and implement HIPAA-compliant billing systems as soon as possible.

For more HIPAA information, visit the HIPAA Help Center.