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Meaningful Health Care Informatics Blog

Jan 7 2013   8:50PM GMT

CMS delays enforcement rules for HIPAA covered entities

Posted by: RedaChouffani
Affordable Care Act, CMS, HIPAA

The Centers for Medicare & Medicaid Services’ Office of E-Health Standards and Services announced a delay to their enforcement of compliance with the operating rules around health care claim statuses and eligibility. This delay affects HIPAA covered entities, including  hospitals, physicians practices, clearinghouses and health plans.

The delay only affects the enforcement of the ruling, the deadline itself stayed as Jan. 1, 2013. The official announcement states that the delay was mainly due to industry feedback that suggested that a threshold has not been reached where most covered entities would be able to be in compliance with the operating rules by the deadline.

The press release also outlines the following:

Although enforcement action will not be taken, OESS will accept complaints associated with compliance with the operating rules beginning January 1, 2013. If requested by OESS, covered entities that are the subject of complaints (known as “filed-against entities”) must produce evidence of either compliance or a good faith effort to become compliant with the operating rules during the 90-day period. HHS will continue to work to align the requirements under Section 1104 of the Affordable Care Act to optimize industry’s ability to achieve timely compliance.

There are still organizations such as home health and other entities who utilize systems that are facing significant challenges adopting some of the new standards, though many of the covered entities have been upgrading their systems to ensure compatibility with the X12 standards version 5010 for claim status check and eligibility.

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