October 2002 AAOS Report

HIPAA TCS compliance deadline looms

Individuals and organizations that are "covered entities" under HIPAA were originally required to comply with the Transactions and Code Sets (TCS) regulations by Oct. 16, 2002. Congress has extended the deadline by one year, to Oct. 16, 2003, for all covered entities that submit a Compliance Plan to the Centers for Medicare and Medicaid Services (CMS) before Oct. 16, 2002. As an orthopaedic surgeon, you are a covered entity if you transmit certain healthcare information electronically to third parties, including insurance claims, payment and remittance notifications, coordination of benefits information and referral certification and authorization.

If you don't engage in these activities, you're not a covered entity, and you need not submit a Compliance Plan. Bear in mind, however, that effective Oct.16, 2003, the Department of Health and Human Services will make payments only on Medicare claims that are filed electronically, except for very small practices. Private payers are likely to follow suit for all practices regardless of their size. Unless you plan to stop participating in all third-party insurance plans and require your patients to submit their own claims, it's likely that, even if you are not a covered entity now, you will soon become one.

If you choose not to use the model form, you may submit your own Compliance Plan as long as it contains the same information. Completing the government's plan will take about 20 minutes. If you cannot locate a hard copy of the compliance form, which was published in the Federal Register on April 15, 2002, call Steven Fisher, AAOS manager of practice management affairs, at (847) 384-4331.

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