• Urgent! Action Needed for HIPAA Deadline Extension
  • December 30, 2003 | Author: Don B. Weinbren
  • Law Firm: Trenam, Kemker, Scharf, Barkin, Frye, O'Neill & Mullis Professional Association - Tampa Office
  • As you may be aware, the federal Health Insurance Portability and Accountability Act of 1996, commonly known as HIPAA, requires health care providers, including physicians and physician groups, to comply with new national standards for electronic health care transactions ("Electronic Billing Standards").

    All health care providers that bill electronically are required to comply with these new Electronic Billing Standards. Failure to comply can result in the imposition of civil and criminal penalties -- including fines and imprisonment. The law also gives a private right of action for damages incurred by a patient whose protected health information is improperly disclosed.

    The original deadline for complying with the Electronic Billing Standards was October 16, 2002. A new law passed in December 2001 extended the deadline to October 16, 2003. However, the extension applies only to health care providers who submit a plan to the government before October 16, 2002.

    Every health care provider should obtain an extension, even if the provider believes that he, she or it is already in compliance or that the Electronic Billing Standards do not apply. The extension relieves the provider of the responsibility (and potential liability) for complying with the Electronic Billing Standards for one additional year.

    Even if the provider is in compliance, the absence of an extension could mean the provider would be liable for a failure to comply by any vendor (e.g., billing company, billing clearinghouse, application software supplier), if the failure occurs before October 16, 2003.

    To obtain the one-year extension, each provider must file a plan with the Centers for Medicare and Medicaid Services (CMS) describing how the provider will comply with the Electronic Billing Standards. By filing a plan, a provider documents its willingness and "intent to comply" with the law. This intent could be a very important defense if the provider is ever challenged for a violation.

    CMS has created a four-page "model" plan form that providers can fill out and submit to CMS by mail or electronically over the Internet. The model is designed to aid providers in disclosing to CMS what steps have been taken, or are planned to be taken by October 16, 2003, to meet the requirements of the Electronic Billing Standards. The form can be found online at www.cms.gov/hipaa/hipaa2/ASCAForm.asp.

    The form must be carefully completed. Submitting a false or inaccurate statement in the form could cause the provider to fail to qualify for the extension, making the provider's compliance date October 16, 2002, and could also expose a provider to separate penalties.

    In addition, the provider will need to send letters to vendors and suppliers to confirm that they are aware of the Electronic Billing Standards and are taking steps to comply by the applicable date (whether or not it is being extended).

    Although the October deadline seems distant, it is best to ensure that your plan is filed in plenty of time to meet the deadline.