CMS Compliance Review Program Logistics Presentation Slides and How - - PowerPoint PPT Presentation

CMS Compliance Review Program

CMS, WEDI and CAQH CORE Webinar Series: Part 2

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.

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Session Outline

▪ Speaker Introduction ▪ Featured Presentation: Administrative Simplification Enforcement – Compliance Review Program ▪ Q&A ▪ Closing Comments

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Thank You to Our Speakers

Paul Anderson Health Insurance Specialist CMS Division of National Standards Charles Stellar President and CEO WEDI April Todd Senior Vice President CAQH CORE

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Gladys Wheeler Lead Health Insurance Specialist for Compliance Enforcement CMS Division of National Standards

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.

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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.

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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.

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Compliance Review Process

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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.

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Optimization Pilot Program Results Violations

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57% 20% 19% 4% Transactions Code Sets Unique ID Operating Rules

Audience Q&A

Enter your question into the “Questions” pane in the lower right hand corner of your screen.

Please submit your questions

▪ The slides and webinar recording will be emailed to attendees and registrants in the next 1-2 business days.

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Thank you for joining us!

Website: www.CAQH.org/CORE Email: CORE@CAQH.org @CAQH @WEDIonline Website: www.wedi.org Email: wedi@wedi.org

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Additional Resources

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• 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

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Resources

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

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Contacts – Enforcement Team

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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: 10th revision of the International Statistical Classification of Diseases and Related Health Problems NDC: National Drug Code NPI: National Provider Identifier Standard

Acronym Glossary