Health Information Compliance Alert

Published on Mon Mar 07, 2022 PDF

Figuring out the nuances of the HIPAA Simplification rules and how they apply to your practice’s electronic healthcare transactions can be confusing. But the feds recently updated their compliance training with the top issues they’ve seen on providers’ claims.

Remember: Since 2019, the Centers for Medicare & Medicaid Services (CMS) National Standards Group has been researching HIPAA Simplification rules’ woes. The agency has performed 20 compliance reviews, which reveal that more than $16 billion could be saved if covered entities (CEs) improved their compliance plans and aligned with the HIPAA regulations, a CMS release indicates.

For example: In a new report, CMS breaks down issues, listing incorrectly added patient information as the top problem The “most common violation involved the NM1 Corrected Patient/ Insured segment in Loop 2100,” the report notes. “Covered entities unnecessarily included either a first, middle, or last name, or organization name or ID number in the segment.” CEs logged more than 835 violations on this matter, specifically because they added unnecessary data.

End note: Review the rules and ensure your electronic exchanges are compliant. Find the report with links to more insight, data on CMS claims reviews, and standards at www.cms.gov/files/document/admin-simp-cr-findings-report-2021-07-14.pdf.