HIPAA Transactions Code Sets and Identifiers Update Stanley

HIPAA Transactions, Code Sets and Identifiers Update Stanley Nachimson CMS’ Office of E-Health Standards and Services September 9, 2005 1

Agenda n Office of E-Health Standards and Services n HIPAA Update n National Provider ID n Enforcement Update n End of Medicare’s Contingency Plan for Claims n Real-Time 270/271 Eligibility Query n Industry Initiatives n Questions? 2

Office of HIPAA Standards Key Functions n HIPAA n Regulations and technical assistance n Outreach/Education n Enforcement n Consolidated Health Informatics n E-prescribing 3

Why Change the Office n Growing importance of e-health and CMS’ role n CMS need for a central point of leadership and coordination on e-health (internally and externally) n Recognition of the need to tie standards work and services together n Office created May 27, 2005 4

Office of E-Health Standards and Services (OESS) – Key Functions n Standards are still a major part of the Office n External Standards and Services n HIPAA n E-prescribing n Liaison n HHS and Other Federal Agencies n Outside Organizations n E-Health Strategy and Coordination Team n Developing and Implementing CMS E-Health Strategy n Managing CMS E-Health Portfolio n Building the E-Health Infrastructure n Serving as CMS E-Health Point of Expertise 5

HIPAA Regulations Update n Claims Attachments NPRM – to be published Fall 2005 n 2 nd round of modifications to transactions and code sets NPRM – under development n ICD-10 – considering NCVHS recommendation to adopt ICD-10 6

National Provider Identifier (NPI) n Identifies health care providers or subparts as health care providers in standard transactions n Replaces the use of proprietary and legacy provider identifiers in standard transactions for health care providers and subparts who have been assigned NPIs 7

NPI – Important Dates n 1/23/2004 – Final Rule published n 5/23/2005 – Health care providers could begin applying for NPIs n 5/23/2007 – Compliance date for all covered entities except small health plans n 5/23/3008 – Compliance date for small health plans 8

The National Plan and Provider Enumeration System (NPPES) n Developed under CMS contract n Uniquely identifies health care providers and subparts and assigns them NPIs n Sets up and maintains a record for every enumerated health care and provider subpart n Creates reports and output files 9

Release of data from the NPPES n Broad discussion in NPI Final Rule n Release must be compatible with So. R Notice, authorities, statutes n Data Dissemination Notice to be published in the Federal Register 10

The NPI Enumerator n Handles paper NPI Application/Update Forms n Resolves problems/answers questions n CMS awarded contract to Fox Systems 11

NPI Enumeration Resources n You may go to https: //nppes. cms. hhs. gov to apply for an NPI. n You may contact the Enumerator Customer Service at: 1 -800 -465 -3203 n TTY 1 -800 -692 -2326 n customerservice@enumerator. com n 12

NPI Implementation Activities n Check CMS website for updates n Watch for instructions/communications from HHS/CMS, trading partners, professional associations n Determine impact of NPI on contracts, systems, processes, files n Develop implementation plans and discuss them with trading partners, vendors, business associates n Identify/resolve issues early 13

HIPAA Enforcement Update Transactions and Code Sets: n 371 complaints received to date n Top reasons include: n compliant claims rejected n code set issues n trading partner issues 14

HIPAA Enforcement Update Security: n 30 complaints received to date n Top reasons include: n administrative safeguards n technical safeguards n physical safeguards 15

Medicare Ends Contingency Plan for Claims Background: n In 2003, Medicare announced a contingency plan covering each of the HIPAA transaction standards n By early 2005, more than 99. 5% of electronic claims sent to Medicare fee-for-service contractors were in a HIPAA format 16

Medicare Ends Contingency Plan for Claims (cont) n Based on statistics and outreach results, Medicare determined there was no longer justification to continue the contingency plan for claims n Medicare will reject electronic claims that are not HIPAA-compliant effective October 1, 2005 17

Medicare Contingency Plans for Other Transactions n Medicare is continuing to monitor statistics and conduct outreach on other HIPAA transactions standards n Adequate notice will be given prior to the termination of contingency plans for other transactions 18

Medicare 270/271 Transaction n The CMS 270/271 Eligibility Transaction via the Medicare Extranet went live May 31, 2005 n To date, 9 clearinghouses are in production n Industry feedback is positive 19

Medicare 270/271 Transaction n Infrastructure and policies still under development for Internet access n CMS 270/271 eligibility transaction via the Internet expected to be available April 2006 20

Industry Initiatives n WEDI n ROI n Acknowledgements n CAQH n CORE Eligibility Business Rules 21

CMS HIPAA Resources n HIPAA Administrative Simplification website: www. cms. hhs. gov/hipaa 2 n HIPAA Hotline 1 -866 -282 -0659 n Ask. HIPAA@cms. hhs. gov 22

QUESTIONS? 23