Part B Insider (Multispecialty) Coding Alert

Physician Notes:

CMS Gets In on the HIPAA-Audit Game

Published on Thu Apr 18, 2019

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Plus: MAC Satisfaction Indicator survey is up and running for 2019.

If you weren’t keen on the HIPAA phase two audits, prepare yourself. Because now, CMS has decided to get in on the fun. The agency has added yet another compliance program to its ehealth renaissance — this time with a HIPAA-edge.

Context: The CMS Division of National Standards has launched a “Compliance Review Program,” which in a nutshell means more HIPAA audits, the agency indicated in a provider message. Starting sometime this April, the feds will randomly select nine HIPAA-covered entities (CEs) and review their electronic health transactions, ensuring HIPAA Administrative Simplification rule alignment.

Originally, CMS planned to start its audit log with only health plans and clearinghouses, building on a pilot program that HHS initiated in 2018 as a “proactive approach” to compliance. However, providers will now also be included in their own pilot program, the agency related in an April 10 memo.

Details: “Any providers who conduct electronic health care transactions can volunteer for the pilot program on behalf of themselves, not their group practice or hospital, unless authorized by their group practice or hospital to do so,” CMS says. “In April 2019, HHS will select three health care providers from the pool of volunteers to participate.”

The agency will cross-check providers’ HIPAA compliance by weighing their electronic transactions against transaction formats, code sets, and unique identifiers, the CMS release suggests. “Participants will also be able to test whether they comply with operating rules.”

“During the pilot program, participants will work one-on-one with HHS to identify and resolve compliance issues,” notes the CMS fact sheet on the program. “Upon completion of the pilot program, participants will receive a certificate and will be exempt from compliance reviews for 1 year.”

Review the CMS “Compliance Review Program” release and sign up to volunteer at www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/Enforcements/Compliance-Review-Program.html.

In other news…

Don’t hold back on what you think of your Medicare carrier, CMS says. The agency is once again running its MAC Satisfaction Indicator survey, which “is designed to measure your satisfaction as a Medicare provider with the performance of your Medicare Administrative Contractor [MAC],” explains CMS in a provider message.

However, you can’t just vent your frustration, CMS stresses. The MSI is specifically for providers to offer feedback on their MACs.

“The MSI will not measure your satisfaction with other Medicare contractor types such as … Recovery Audit Contractors (RACs), Comprehensive Error Rate Testing (CERT) contractors, Zone Program Integrity Contractors (ZPICs), Supplemental Medical Review Contractors (SMRCs) or Qualified Independent Contractors (QICs),” CMS says.

“The MSI survey is only offered on an annual basis, for a specified window of time, so don’t miss your chance to be heard,” reminds MAC Palmetto GBA.

Find your MAC link and read past results at www.cms.gov/Medicare/Medicare-Contracting/MSI/.