The Department of Health and Human Services has announced that it is looking for volunteers for their HIPAA Administrative Simplification Optimization Project Pilot. Volunteers who are selected will undergo compliance reviews by HHS. The aim of the pilot is to streamline HIPAA compliance reviews for health plans and healthcare clearinghouses.
There is a range of different data formats currently being used for conducting electronic transitions. This variety can cause problems when healthcare organisations attempt to transfer or share data with each other. It is thought that if these channels of communications are made more efficient, and if healthcare organizations comply with the HIPAA Administrative Simplification transaction standards, providers and health plans can devote fewer resources to these tasks. Processes involving billing and insurance related matters will become more streamlined in the process. Compliance with the Administrative Simplification transaction standards will also reduce the burden on compliant entities having to exchange healthcare data with trading partners that are not compliant.
The 2016 CAQH Index showed that industry-wide compliance with the HIPAA Administrative Simplification transaction standards could result in savings of almost $9 billion each year for the healthcare industry. These savings come from the streamlining of current inefficient data handling processes. For savings of this magnitude to be realised, CAQH Index emphasises that industry-wide compliance must be in place.
One of the ways that the HHS can help those in the healthcare industry save this money is by conducting proactive compliance reviews. The purpose of the reviews is to help health plans and other healthcare organizations take action to ensure they are fully compliant with current regulations and guidelines.
The reviews are not intended to identify noncompliance in order to punish healthcare organizations, instead the aim is to help covered entities comply with the Administrative Simplification transaction standards. According to 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 pilot being launched by HHS marks the start of these reviews. The HHS has started their drive of attracting volunteers to take part. In total, the HSS requires six volunteer organizations for the HIPAA Administrative Simplification Optimization Project pilot – three health plans and three healthcare clearinghouses. The pilot involves these reviewing of the organisation’s transactions to assess compliance with the HIPAA Administrative Simplification standards, and will cover code sets, adopted standards, unique identifiers, and operating rules.
Health plans and clearinghouses that join the HIPAA Administrative Simplification Optimization Project pilot will be able to verify compliance or identify noncompliance issues. The compliance reviews will start in January 2018 and will inform the rollout of the Administrative Simplification Optimization Program.
Organizations who volunteer to participate in the reviews will have to submit electronic transaction files, which will be reviewed and tested by the HHS. The HHS suggests the process of submitting electronic files for review should take no longer than 10 hours. Further details of the pilot reviews will be supplied to participants that are selected to take part in the pilot.
Once the reviews have been conducted, all participants that have successfully passed a review will be provided with a certificate by the HHS. Volunteers will be able to share with their partners and business associates to indicate their compliance HIPAA Administrative Simplification standards.
If non-compliance is discovered, the HHS will provide guidance on areas for optimization and a corrective action plan will need to be developed by the volunteers to address compliance issues.
Any organization that takes part in the pilot will not be selected for a further review for one year following the launch of the HHS Administrative Simplification Optimization Program.
The HHS is accepting applications for the HIPAA Administrative Simplification Optimization Project pilot by email – HIPAAcompliant@cms.hhs.gov. Volunteers will be chosen from the pool of applicants that have applied by December 13, 2017. All organizations that apply will be notified whether they have been selected or not by December 27, 2017.