California Physician

Is your practice transmitting HIPAA-compliant electronic claims? Your cash flow is in jeopardy if you are not certain that your practice has successfully made the transition to a HIPAA-compliant billing system.

After July 1, Medicare payments will be delayed for two weeks if they aren’t submitted in compliance with HIPAA’s electronic transactions rule. Physicians will be penalized for noncompliant claims, even if a third-party biller is at fault.

In October, Medicare recognized the low level of HIPAA-readiness among physicians and implemented a contingency plan under which carriers would accept both the new formats and the old electronic formats. This “grace period” will soon be over. The agency called the two-week payment delay “a measured step toward ending the contingency plan completely.”

There are still some billing services, clearinghouses, and practice management software vendors that are not yet able to submit compliant electronic claims. If you are concerned about your practice’s ability to submit HIPAA-compliant claims, consider using Infinedi, the CMA-sponsored clearinghouse. CMA has confirmed with NHIC (California’s Medicare carrier) that Infinedi is successfully clearing Medicare claims. Infinedi reports to CMA that it files daily batches with close to a 100 percent acceptance rate.

Physicians can choose Infinedi’s flat rate monthly service, which permits unlimited electronic claim filing, or opt for a per-transaction payment plan. CMA members receive a discount of 8 to 12 percent.

Enrollment is risk-free. If Infinedi is unable to convert your existing claims into the new HIPAA formats, the one-time $175 enrollment fee is refunded. (The enrollment fee for nonmembers is $200.)

For more information on how to minimize claims delays or denials, see the CMA/PrivaPlan TCS ToolKit CD-ROM. The inexpensive CD-ROM contains a tool to help physicians map their claims data from the existing HCFA 1500 claim form to the new HIPAA-standard form. It also contains information on how physicians can make their billing systems HIPAA-compliant.

CMA members who previously purchased the CMA/PrivaPlan HIPAA Privacy and Security Toolkit can order this TCS toolkit for $50. The fee for CMA members who do not own the privacy and security toolkit is $75. The nonmember price is $100.

Contact: CMA’s legal information line, 415/882-5144 or legalinfo@cmanet.org.