Medicare Compliance & Reimbursement

Here's what's coming down the administrative simplification highway. Attention rule-watchers: Want to get a legg up on possible upcoming changes to the Health Information Portability and Accountability Act? The Department of Health and Human Services revealed its semiannual regulatory agenda in the June 28 issue of the Federal Register, which covers all rules on deck for review. And according to a release from Phoenix Health Systems, here are the HIPAA regulations in your future:

November, 2004: The proposed Standard Unique National Health Plan Identifier rule would implement a standard identifier for health plans that process and pay certain electronic health care transactions. Claims Attachments Standard: To help establish medical necessity, this rule proposes an electronic standard for claims attachments for clinical data, in addition to data contained in the claims standard. February and March, 2005: Proposed revisions of the HIPAA electronic transactions and code sets standards, as well as proposed replacements for specific code sets.

September 2006: Arriving two years later than expected, this final rule would implement the requirements for certain electronic submissions of Medicare claims as well as the conditions for granting a waiver for these requirements. TBA: Outline for enforcing HIPAA compliance through civil monetary penalties.