Volunteers Needed for HIPAA Administrative Simplification Optimization Project Pilot

The Department of Health and Human Services is seeking volunteers for a pilot project on HIPAA Administrative Simplification Optimization. The purpose of this project is to make HIPAA compliance reviews for health plans and healthcare clearinghouses more efficient.

Why is this pilot project important? It will help improve the process of transferring and sharing healthcare electronic data. Also, when providers and health plans comply with the HIPAA Administrative Simplification transaction standards, they can save more because they will need fewer resources to do what is needed. The 2016 CAQH Index stated that when there is industry-wide compliance with the HIPAA Administrative Simplification transaction standards, the healthcare industry can save $9 billion per year.

To make these savings possible, there must be proactive compliance reviews. Its purpose is to make sure that health plans and healthcare organizations move toward compliance. The purpose is not to punish the noncompliant but to identify and help them comply with the Administrative Simplification transaction standards. Centers for Medicare and Medicaid Services (CMS) announced “a progressive penalty process with the goal of remediation and not punishment.”

The pilot project will start the compliance reviews in January 2018 with six volunteer organizations, three healthcare clearinghouses and three health plans. The HHS will review their transactions and determine their compliance with the HIPAA Administrative Simplification standards. The review will also cover code sets, unique identifiers, adopted standards and operating rules.

The volunteer health plans and clearinghouses will be able to verify if they comply with the HIPAA Administrative Simplification standards. If not, they will be able to identify the noncompliance issues and get guidance on optimizing and correcting the issues. The HHS will review submitted electronic transaction files and once the volunteer organizations successfully pass the review, they will be issued a certificate by the HHS.

Volunteer organizations that will be part of the pilot project will not be required for further review for one year after the launching of the HHS Administrative Simplification Optimization Program. Organizations that want to volunteer may send their applications for the HIPAA Administrative Optimization Project pilot to HIPAAcompliant@cms.hhs.gov until December 13, 2017. All applicants will receive a notification by December 27, 2017 whether they were chosen or not.