By Sheila M. Press, Attorney Sheila M. Press, Attorney HIPAA, the acronym for the Health Insurance Portability and Accountability Act of 1996, is on everyone's mind. Often, these thoughts are accompanied by a scream of "Help!" It is true that the compliance date for HIPAA Standards for Electronic Transactions and Code Sets is October 16, 2002. However, the government has provided help by permitting certain health care providers, including O&P providers, to obtain a one-year extension for compliance with HIPAA's electronic billing requirements. In order to qualify for the extension, you MUST FILE a proposed compliance plan. A model form can be downloaded from: http://www.cms.hhs.gov/hipaa2. You can submit the completed form electronically or mail it to: ATTN: Model Compliance Plans, Center for Medicare and Medicaid Services, PO Box 8040, Baltimore, MD 21244-8040. The following information should help you to complete this model form: Section A: Covered Entity and Contact Information Name of covered entity: Write your facility's name. Tax Identification Number: This would be your facility's employer identification number (EIN) as issued by the IRS. Medicare identification number. Write in your Medicare provider (NSC) number. Type of covered entity. You are a "health care provider." Authorized person and contact information. Write in the name of the person in your facility is has been authorized to request the extension. Section B: Reason for Filing This Extension This is a list of reasons why you need the extension. The most likely choices are either "waiting for vendor(s) to provide software" or "waiting for clearinghouse/billing services to update my software." Section C: Implementation Budget 2. A range for your estimated costs to comply with this HIPAA rule is provided. A good estimate would depend on your cost to update your billing software or billing services to become HIPAA compliant. Section D: Implementation Strategy Phase One: HIPAA Awareness 3. Your general understanding of the HIPAA Standards for Electronic Transactions and Code Sets. You can answer "yes" to this question if (1) you have obtained information regarding this issue; (2) you have discussed this information with your vendor(s); and (3) you have conducted some preliminary staff training. If you are able to answer "yes" to #12, proceed to #14, which asks when you completed this phase. If you answer "no" to #12, answer #13 which asks when you plan to start this process, and you mist also provide an estimated completion date in #14. Phase Two: Operational Assessment 15. Your assessment of what your facility needs to do to comply with the HIPAA Standards for Electronic Transactions and Code Sets. You can answer "yes" here if (1) you have identified your non-HIPAA compliant software; (2) you have developed a plan to address implementation of HIPAA compliant software (have you contacted you software vendor and your DMERC to know when HIPAA compliant software will be available and when the DMERC will be testing this?); and (3) have you decided whether to continue using your present software or to use another vendor or to use a clearinghouse to help you become HIPAA compliant? If you can answer "yes" to #15, proceed to #20, which asks when you completed this phase. If you answer "no" to #15, then you must answer #16-19, which ask when you plan to start or have started the 3 items above. You must also provide an estimated completion date in #20. Phase three: Development and Testing Testing your claims submissions must begin no later than April 16, 2003. 21. Asks if you have completed the development and testing phase. Most likely, your answer will be "no." 22. Asks if you have completed software development installation. Most likely, your answer will be "no." 23. Asks if you have completed staff training. Most likely, your answer will be "no." 24-26 Ask for estimated completion dates for #21-23. Sometime in summer, 2003 would probably be appropriate. It is of utmost importance that you submit this form, as it is it is unlikely that your billing software vendors will be HIPAA compliant by this October. Remember, if your billing software is not HIPAA compliant, you are not HIPAA compliant. Sheila M. Press, Attorney, is president of Healthcare Compliance Solutions, a company providing consulting services, including HIPAA and OIG compliance, and customized compliance programs for O&P. She can be reached at 480.767.9477; e-mail: spress@hccsolutions.com; www.hccsolutions.com
