Medicare Fee-For-Service Policy Regarding 90 Day Discretionary Enforcement Period for Non-Compliant HIPAA Covered Entities

From CMS this morning.

Medicare Fee-For-Service (FFS) Policy Regarding 90 Day Discretionary Enforcement Period for Non-Compliant HIPAA Covered Entities 

CMS announced on Thu Nov 17, that it would not initiate enforcement action with respect to any HIPAA covered entity that is non-compliant with the ASC X12 Version 5010 (Version 5010), NCPDP Telecom D.0 (NCPDP D.0), and NCPDP Medicaid Subrogation 3.0 (NCPDP 3.0) standards until 90 days after the Sun Jan 1, 2012 compliance date.  Notwithstanding CMS’ discretionary application of its enforcement authority, the compliance date for use of these new standards remains Sun Jan 1, 2012.

The announcement can be found at http://www.CMS.gov/ICD10/02b_Latest_News.asp.

What The 90 Day Enforcement Discretionary Period Means For Medicare Fee-For-Service:

Medicare FFS has experienced significant increases in 5010 production transactions during the last few months.  However, there are many submitters that have tested but not taken the step to move into production for 5010 and D.0.  In addition, there are many submitters that have not yet initiated testing with their Medicare Administrative Contractor (MAC).  Therefore, to ensure that progress continues to be made, Medicare FFS is planning to take the following steps for submitters and receivers of Medicare Part B and Durable Medical Equipment (DME) transactions.  Submitters and receivers of Medicare Part A transactions will follow the same action plan starting 30 days after Part B and DME:

 

• In December 2011, submitters/receivers that have tested and been approved for 5010/D.0 will be notified that they have 30 days to cutover to the 5010/D.0 versions.
• Submitters/receivers that have not yet tested will be notified in December 2011 that they must submit their transition plan and timeline to their MAC in 30 days.
• MACs will notify the submitters/receivers; submitters/receivers have the responsibility to notify the providers they service.

For more information on ASCX12Version 5010, NCPDP D.0, and NCPDP 3.0; please visit www.CMS.gov/Versions5010andD0.

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It’s a Busy Time of Year. Make each office visit an opportunity to talk with your patients about the importance of getting the seasonal flu vaccination and a one-time pneumococcal vaccination. Remember, Medicare pays for these vaccinations for all beneficiaries with no co-pay or deductible. The seasonal flu and invasive pneumococcal disease kill thousands of people in the United States each year, most of them 65 years of age and older. The Centers for Disease Control and Prevention (CDC) also recommends that healthcare workers and caregivers be vaccinated against the seasonal flu. Protect your patients. Protect your family. Protect yourself. Get the Flu Vaccine—Not the Flu.

Remember – The flu vaccine plus its administration are covered Part B benefits.  CMS has posted the 2011-2012 seasonal flu vaccine payment limits at http://www.CMS.gov/McrPartBDrugAvgSalesPrice/10_VaccinesPricing.asp.  Note that the flu vaccine is NOT a Part D-covered drug. 

For more information on coverage and billing of the flu vaccine and its administration, as well as related educational provider resources, visit http://www.CMS.gov/MLNProducts/35_PreventiveServices.asp and http://www.cms.gov/immunizations.

Note:  If you have problems accessing any hyperlink in this message, please copy and paste the URL into your Internet browser. 

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If you would like to unsubscribe from a specific provider listserv, please go to (https://list.nih.gov/cgi-bin/wa.exe?INDEX) to unsubscribe or to leave the appropriate listserv.

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