About HIPAA

If a claim is error free is it HIPAA compliant?
Not necessarily. HIPAA compliance regulates the format of the claims submission as well as the rules of submission, such as those pertaining to privacy and security. A claim can pass the syntax testing (i.e. Claredi and Validator) and still contain errors in the data submitted or the business requirements for each payer.

Is sending data on a disc considered an electronic transaction?
Yes.

Does the law require physicians to buy computers?
No, there is no such requirement. However, more physicians may want to use computers for submitting and receiving transactions (such as health care claims and remittances/payments) electronically. The Administrative Simplification provisions of the HIPAA law were passed to support the health care industry. HIPAA law requires that all transactions submitted electronically comply with the standards. Providers, even those without computers, may want to adopt these standard electronic transactions, so they can benefit directly from the reductions in cost. This is possible because the HIPAA law allows providers and health plans to contract with clearinghouses to conduct the standard electronic transactions for them.

Does MDCH expect that the CEO will certify each data submission?
MDCH has not yet developed guidelines for that process. It is not required until August 2003.

Will date of service determine the claim format after October 1, 2002?
No, the date of submission will determine the format after October 1, 2002. You must use the new format for all claims submitted after Oct 1, 2002, despite the date of service.

The schedule for Nursing Facilities implementation is contained in the L-02-25 letter issued by MDCH. This Provider letter addresses the Nursing Facilities delay in implementation of the 837 I format. This letter is available at www.michigan.gov/documents/NF_Sept_Numbered_letter_L-02-25_42268_7.pdf.

The schedule for the implementation of the other transactions is available on the Michigan Virtual University website at healthcare.mivu.org. These are on-line courses and are available via the Internet 7 days a week, 24 hours a day.

Does the law also require Medicare claims to be submitted electronically after October 2003?
HIPAA Administrative Compliance Act (ASCA) prohibits Health and Human Services (HHS) from paying Medicare claims that are not submitted electronically after October 16, 2003, unless the Secretary of HHS grants a waiver from this requirement. It further provides that the Secretary must grant such a waiver if there is no method available for the submission of claims in electronic form or if the entity submitting the claim is a small provider of services or supplies. Beneficiaries will also be able to continue to file paper claims if they need to file a claim on their own behalf. The Secretary may grant such a waiver in other circumstances. CMS will publish proposed regulations to implement this new authority.

Is it true that HIPAA wants the states to give providers one unique number that they can use to bill both Medicare and Medicaid. Is Michigan doing this?
Currently Michigan does not have any plans to use the same ID number for both Medicare and Medicaid. Medicare’s website is indicating that a Notice of Proposed Rule Making (NPRM) will be coming out recommending the adoption of a national provider identification number which would cover many professions and facilities. This would be done centrally and would apply to all payers, not just Medicare and Medicaid.

Whose responsibility is it to make a provider compliant?
The provider is responsible for the data he transmits. The vendor dealing with the provider is responsible for format and compliance. They both will need to work with each other to ensure compliancy. However it will be the ultimate responsibility of the provider to transmit HIPAA compliant claims.