1. 2003;6;521-525Update: Electronic Transactions, HIPAA, and Medicare Reimbursement
   A Practice Management
   Erin Brisbay McMahon,, JD.

Physician practices that transmit any health information in electronic form in connection with a transaction covered by the HIPAA transactions and code sets rule will be required to comply with the rule no later than October 16, 2003. Under the rule, if certain transactions, such as the filing of claims, are conducted electronically, they must contain certain data content and be formatted in a particular way.

On and after October 16, 2003, Medicare will require claims to be submitted electronically unless a physician practice has less than 10 full-time equivalent employees. Practices with fewer than 10 FTEs can continue to submit paper claims to Medicare without any further action on their part.

At a minimum, physician practices must have the ability to capture the data required by the rule for covered transactions conducted electronically, and either use a clearinghouse to translate the data to X12N format or obtain a translator and electronic connectivity to ensure that the practice can send electronically compliant claims by October 16, 2003.

Trading partner agreements may specify the duties and responsibilities of each party to the agreement in conducting a covered transaction electronically, but they are not required under HIPAA. Business associate agreements are required under HIPAA if a practice chooses to use a business associate (a person who performs an activity falling under the rule on behalf of the practice), including a health care clearinghouse, to conduct electronic covered transactions for it, and the agreement must comply with the HIPAA transactions and code sets rule, the privacy rule, and the security rule.

This article is not, and should not be construed as, legal advice or an opinion on specific situations.

Keywords: HIPAA, transactions and code sets, electronic transactions, covered transactions, electronic standards, health claims, health care clearinghouses