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CMS Launches HIPAA Administrative Simplification Compliance Program

On behalf of the Department of Health and Human Services (HHS), the Centers for Medicare & Medicaid Services’ Division of National Standards has launched a review program to ensure compliance with Health Insurance Portability and Accountability Act (HIPAA) administrative simplification rules for electronic health care transactions.

HHS in April will randomly select nine HIPAA-covered entities, including health plans and clearinghouses, to review for compliance with national standards for transaction formats, code sets, and unique identifiers. The compliance review program periodically will review randomly selected entities, and health care providers also can participate in a voluntary 2019 pilot program.

This new compliance program supplements the Administrative Simplification Enforcement and Testing Tool, which allows anyone to file a complaint or test a transaction online.

HHS also published a question-and-answer document to assist entities in understanding scope and expectations related to compliance reviews.

To share questions or comments with HHS, email AdministrativeSimplification@cms.hhs.gov. For additional questions, contact Senior Director of Policy Erin O’Malley at eomalley@essentialhospitals.org or 202.585.0127.

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About the Author

Emily Schweich is a communications associate for America's Essential Hospitals.