CMS Considers Ending Contingency
Plan Period for HIPAA

As you know, the Health Insurance Portability and Accountability Act (HIPAA) began requiring the use of standard code sets in October 2003. However, in order to avoid disruption of claims payment during the implementation period, Humana instituted a contingency plan, which allowed noncompliant codes to be accepted while providers made good-faith efforts to become fully compliant. However, indications from the Centers for Medicare and Medicaid Services (CMS) are that steps are now being taken to end the contingency plan period as soon as possible.

CMS is closely reviewing the progress on HIPAA compliance to determine when it can end the contingency plan. As of May 7, 2004, according to the CMS Web site, www.cms.gov, 83.4 percent of electronic claims are being submitted to Medicare in a HIPAA-compliant format. CMS expects the change in claims payment timeliness will greatly increase this compliance percentage, allowing the contingency plan period to be brought to an end soon.

One issue that may present problems for some facilities is that ICD-9 procedure codes are not compliant for outpatient claims. Outpatient facility claims should contain CPT or HCPCS codes, not ICD-9 procedure codes.

If any issue prohibits you from filing claims that are fully HIPAA compliant, contact Humana Customer Service at 1-800-4 HUMANA (1-800-448-6262).

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