Two HIPAA Operating Standards Delayed Until March 31

Last Wednesday CMS announced it has delayed the enforcement date for certain operating rules for HIPAA transaction standards.  Enforcement of the first two operating rules for HIPAA transaction standards has been delayed until March 31, 2013. The official announcement from CMS’ Office of E-Health Standards and Services (OESS) said the delay was to avoid potential significant disruption to the healthcare industry with respect to HIPAA covered entities. Covered entities include but are not limited to office-based physicians, health insurers, hospitals, and clearing houses.The operating rules are intended to make the application of the HIPAA standards more consistent and efficient. These operating rules that went into effect on January 1, 2013.

“Industry feedback suggests that HIPAA covered entities have not reached a threshold whereby a majority of covered entities would be able to be in compliance with the operating rules by Jan. 1,” according to a CMS statement. “This enforcement discretion period does not prevent applicable HIPAA covered entities that are prepared to conduct transactions using the adopted operating rules from doing so.”

The announcement makes clear, however, that this enforced discretionary period does not prevent applicable HIPAA covered entities that are prepared to conduct transactions from using the adopted operating rules. Covered entities subject to complaints might be asked to produce evidence of either compliance or a good-faith effort to become compliant with the operating rules during this delayed period. According to CMS “all applicable covered entities are encouraged to determine their readiness to use the operating rules” and “expeditiously become compliant.” CMS’ Office of E-Health Standards and Services “will accept complaints associated with compliance with the operating rules” as of Jan. 1, and if requested by the standards and services office, “covered entities that are the subject of complaints must produce evidence of either compliance or a good-faith effort to become compliant with the operating rules during the 90-day period.”

For copies of the operating rules for the eligibility for a health plan and health care claim status transactions, visit the Council for Affordable Quality Healthcare  website. Information on the operating rules for eligibility for a health plan and
health care claim status are available on the CMS website.