Medicare Compliance & Reimbursement

If the HIPAA Administrative Simplification provisions that impact your electronic transactions have you scratching your head, you’re not alone. But there are several online offerings that can help you with your questions.

CE basics: You may be unsure of whether you’re a covered entity (CE). The Centers for Medicare & Medicaid Services (CMS) offers individuals and organizations the opportunity to determine their CE status with a decision tree. The online tool guides healthcare providers, plans, and clearinghouses through a series of questions about the Administrative Simplification requirements and HIPAA while assisting with the CE determination.

You can find the the tool at www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/HIPAA-ACA/ Downloads/CoveredEntitiesChart20160617.pdf.

Fact sheets: CMS also “created a series of fact sheets to help explain how HIPAA electronic adopted transactions streamline health care billing through the use of standards and operating rules,” mentions a CMS alert. The fact sheets cover an amalgam of topics including:

• HIPAA eligibility and benefits
• Electronic funds transfer and remittance advice
• Claims status
• Health plan eligibility, benefits, and transactions
• Clearinghouse electronic remittance advice
• Coordination of benefits

On top of this guidance that targets specific areas of the HIPAA Administrative Simplification requirements, CMS also lists the standards for transactions and has a fact sheet dedicated to the basics of the provision, highlighting the regulation’s origin to improve efficiency, cut costs, and enhance quality care.

Peruse the various fact sheets at www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/Transactions/ TransactionsOverview.