CMS Adds Information for Administrative Simplification

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  • April 11, 2017
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CMS Adds Information for Administrative Simplification

The Centers for Medicare & Medicaid Services (CMS) unveiled a fact sheet to improve understanding of HIPAA’s least-known provision, Administrative Simplification. The FAQ helps explain the three-pronged approach to simplification: electronic transactions, code sets, and unique identifiers.
CMS said the fact sheet explains how Administrative Simplification standards streamline day-to-day tasks such as:

  • Billing
  • Verifying patient eligibility
  • Sending and receiving payment

The standards apply to entities who exchange health care information electronically, including health plans, healthcare providers, and clearinghouses. The new fact sheet also covers: Benefits of Administrative SimplificationTypes of standards, and Enforcement of standards.

The Fact Sheet

CMS maintains the standards simplify day-to-day tasks like billing, verifying patients’ eligibility, and sending and receiving payments. The agency reminds the provider that the standards can be used to streamline processes, receive payments more quickly, obtain timely information, and check claim status.
There are four types of standards that form the foundation of the electronic data interchange standard:

  • Transaction for pharmacy and healthcare administrative information
  • Operating rules to support standard transactions
  • Unique identifiers for health plans, provider,s and employers
  • Code sets for diagnoses and procedures.

CMS also reminds providers of the Administrative Simplivication Enforcement and Testing Tool (ASETT) to file complaints and test transactions.

HIPAA’s Other Legs

HIPAA, which was signed into law by President Bill Clinton in 1996, has two other legs holding it up. One leg is guaranteeing the privacy of patients, and the other is assuring security of patient health information. All covered entities and business associates, must comply. Covered entities include healthcare providers, health plans, and healthcare clearinghouses.

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Brad Ericson
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Brad Ericson, MPC, CPC, COSC, is a seasoned healthcare writer and editor. He directed publishing at AAPC for nearly 12 years and worked at Ingenix for 13 years and Aetna Health Plans prior to that. He has been writing and publishing about healthcare since 1979. He received his Bachelor's in Journalism from Idaho State University and his Master's of Professional Communication degree from Westminster College of Salt Lake City.

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