CMS, WEDI and CAQH CORE Webinar Series: Part 2 CMS Compliance Review Program
Logistics Presentation Slides and How to Participate in Today’s Session ▪ You can download the presentation slides at www.caqh.org/core/events or at www.wedi.org after the webinar. ▪ A copy of the slides and the webinar recording will be emailed to all attendees and registrants in the next 1-2 business days. ▪ Questions can be submitted at any time using the Questions panel on the GoToWebinar dashboard. 2
Session Outline ▪ Speaker Introduction ▪ Featured Presentation: Administrative Simplification Enforcement – Compliance Review Program ▪ Q&A ▪ Closing Comments 3
Thank You to Our Speakers Gladys Wheeler Paul Anderson Lead Health Insurance Specialist Health Insurance Specialist for Compliance Enforcement CMS Division of National Standards CMS Division of National Standards Charles Stellar April Todd President and CEO Senior Vice President WEDI CAQH CORE 4
Administrative Simplification Enforcement Compliance Review Program July 18, 2019
Compliance Review Program » Created to ensure compliance amongst covered entities with HIPAA Administrative Simplification rules for electronic health care transactions. » The Compliance Review Program will conduct periodic reviews with randomly selected entities to assess compliance with HIPAA Administrative Simplification rules. 6
Compliance Review Program Cont’d » HHS will review the following administrative transactions for compliance: 1) Transaction formats 2) Code Sets 3) Unique Identifiers » Participants will attest to compliance with operating rules. 7
Non-compliance » Covered entities found to be noncompliant will be allowed to undertake corrective actions. » Covered entities who do not achieve compliance may be subjected to escalated enforcement actions. 8
Compliance Review Process 9
Optimization Pilot Program » In 2018, ten organizations were selected to participate in the pilot program. Four clearinghouses and one health plan completed the pilot. » Participating organizations assisted HHS with optimizing the review process, including review tracking, coordinating and communicating with participating entities, and assessing violations. 10
Optimization Pilot Program Results Violations 4% 19% 57% 20% Transactions Code Sets Unique ID Operating Rules 11
Audience Q&A Please submit your questions Enter your question into the “Questions” pane in the lower right hand corner of your screen. ▪ The slides and webinar recording will be emailed to attendees and registrants in the next 1-2 business days. 12
Thank you for joining us! @WEDIonline @CAQH Website: www.wedi.org Website: www.CAQH.org/CORE Email: wedi@wedi.org Email: CORE@CAQH.org 13
Additional Resources 14
Resources • go.cms.gov/adminsimp website • Administrative Simplification Email Updates • Compliance Review video at https://youtu.be/iRF8TvaW4DU • ASETT to test transactions or file complaints at asett.cms.gov • AdministrativeSimplification@cms.gov for questions and comments • CAQH 2017 Index and savings calculator at CAQH.org DNS Regional Office Engagement SharePoint site • 15
Contacts – Enforcement Team Madhu Annadata – Madhusudhan.Annadata@cms.hhs.gov Chris Gerhardt- Christine.Gerhardt@cms.hhs.gov Gladys Wheeler – Gladys.Wheeler@cms.hhs.gov Geanelle Herring – Geanelle.Herring@cms.hhs.gov Cecily Austin – Cecily.Austin@cms.hhs.gov Rosali Topper – Rosali.Topper@cms.hhs.gov Paul Anderson – Paul.Anderson@cms.hhs.gov 16
Acronym Glossary ASETT: Administrative Simplification Enforcement and Testing Tool CDT: Code on Dental Procedures and Nomenclature CPT: Current Procedural Terminology DNS: Division of National Standards EHRs: electronic health records EIN: Employer Identification Number HCPCS: Healthcare Common Procedure Coding System HIPAA: Health Insurance Portability and Accountability Act of 1996 ICD-10: 10 th revision of the International Statistical Classification of Diseases and Related Health Problems NDC: National Drug Code NPI: National Provider Identifier Standard 17
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