A HIPAA Administrative Simplification Optimization Project Pilot is being operated by The Department of Health and Human Services is currently inviting volunteers to have compliance audits. The focus of the project is to streamline HIPAA compliance audits for health plans.
At present, a range of data formats are used for completing electronic transitions. That variety can create issues when moving data. If communications regarding billing and insurance related matters are streamlined and healthcare groups adhere with the HIPAA Administrative Simplification transaction standards, providers and health plans can dedicate fewer resources to these duties. Compliance with the Administrative Simplification transaction standards will also lessen the burden on compliant bodies having to exchange healthcare information with trading partners that are not adhering.
The 2016 CAQH Index says that industry-wide compliance with the HIPAA Administrative Simplification transaction standards could lead to savings of almost $9 billion each year for the healthcare sector. However, for those savings to be incurred, there must be sector-wide compliance.
One of the manners that allows the HHS to make these savings is by completing proactive compliance audits. The aim of the reviews is to help health plans and other healthcare groups take action to ensure adherence.
The reviews are not aiming to find noncompliance in order to punish healthcare groups, instead the focus is to help covered entities adhere with the Administrative Simplification transaction standards. In a recent email communication from the Centers for Medicare and Medicaid Services (CMS), there will be “a progressive penalty process with the goal of remediation, not punishment.”
The reviews will begin with a pilot, for which the HHS is now inviting volunteers. In total, the HSS needs six volunteer groups for the HIPAA Administrative Simplification Optimization Project pilot – three health plans and three healthcare clearinghouses. Organizations were not included in the pilot will be subjected to an audit of their transactions to assess compliance with the HIPAA Administrative Simplification standards, and will cover code sets, adopted standards, unique identifiers, and operating proccesses.
Health plans and clearinghouse that sign up to the HIPAA Administrative Simplification Optimization Project pilot will be able to discover compliance or identify noncompliance issues. The compliance reviews will begin in January 2018 and will advise the rollout of the Administrative Simplification Optimization Program.
The reviews will need volunteer organizations to register electronic transaction files, which will be examined and tested by the HHS. The HHS suggests the process of submitting electronic files for audit should take no longer than 10 hours. More details of the pilot reviews will be given to participants that are selected to take part in the pilot.
Once the reviews have been finished, all participants that have successfully passed a review will be given a certificate by the HHS, which volunteers will be able to collaborate on with their partners and business associates.
If non-compliance is identified, the HHS will give guidance on areas for optimization and a corrective action plan will need to be developed by the volunteers to address compliance problems.
Any group that takes part in the pilot will not be chosen for a further review for one year after the launch of the HHS Administrative Simplification Optimization Program.
The HHS is inviting applications for the HIPAA Administrative Simplification Optimization Project pilot via email – HIPAAcompliant@cms.hhs.gov – with volunteers picked from all applicants by December 13, 2017. All groups that apply will be advised whether they have been chosen or not before December 27, 2017.