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HHS Pilot Encourages Streamlined Health Plan HIPAA Compliance

HHS is looking for health plans to volunteer for an administrative simplification pilot focused on HIPAA compliance.

HHS pilot encourages streamlined health plan HIPAA compliance

Source: Thinkstock

By Thomas Beaton

- HHS is launching a pilot program that streamlines reviews of health plan HIPAA compliance, the organization announced in an email to the CMS listserv.

The HHS HIPAA Administrative Simplification Optimization Project pilot is an effort to achieve the full benefits of industry-wide standardized HIPAA compliance. Improved HIPAA compliance could bring potential savings of $9 billion to the healthcare industry, said the 2016 CAQH Index.  HHS believes these savings are achievable through proactive compliance procedures for health plans.

Health plans, providers, and clearinghouses have encouraged HHS to use compliance reviews to ensure administrative simplification transaction standards reduce burdens on compliant stakeholders, CMS said, and urged the agency to streamline communications about billing and insurance updates.

“We intend that our compliance reviews for use of the HIPAA Administrative Simplification transaction standards will result in an environment that requires minimal government intervention because entities are conducting electronic transactions in adopted standard formats,” CMS said in the listserv email.

HHS is looking for three health plans and three clearinghouses to participate in the program.

The selected health plans and clearinghouses will submit electronic files for review and testing and will also attest to compliance with operating rules. The transaction submission has an expected completion time of under 10 hours.

After completion, HHS will provide volunteers with a report that identifies any compliance issues that need to be addressed. HHS will determine compliance areas that require optimization during the pilot period. Volunteers will subsequently develop a corrective action plan to fix areas of noncompliance.

Volunteers that successfully complete the plan receive a professional certificate of completion from HHS, which can be shared with colleagues.

The pilot will be used to inform and enhance the the rollout of the larger Administrative Simplification Optimization Program. HHS will then conduct ongoing compliance reviews of health plans and clearinghouses.

Health plans and clearinghouses that took part in the pilot project won’t be subject to random selection for a compliance assessment for one year after the optimization program’s launch.

Health plans and clearinghouses interested in the opportunity to volunteer for the pilot can send an email now to the [email protected] mailbox. Any HIPAA-covered health plan or clearinghouse may volunteer.

The deadline for application is December 13th, 2017, and all applicants (accepted or not) will hear back by December 27th, 2017.

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