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Published byArron Mosley Modified over 8 years ago
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Implementing HIPAA Centers for Medicare & Medicaid Services Fourth National HIPAA Summit April 25, 2002 Jared A. Adair Director Office of Operations Management
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CMS’s Commitment to Implementing HIPAA Office of Operations Management –New –Focal Point for the Agency for Administrative Simplification –Work continues throughout the Agency HIPAA Steering Committee HIPAA Roundtable Discussions
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CMS’s Dual Roles Responsible for regulations that adopt HIPAA standards… …and modifications to those standards Operate health plans that must be compliant –Medicare (fee-for-service and managed care) –Medicaid and SCHIP
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Medicare Fee-for-Service CMS directly responsible for readiness Business partners –Medicare carriers and fiscal intermediaries –Claims processing systems maintainers Environment: Quarterly systems releases
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Medicare FFS - Basic Concepts Can’t do it all at once –Risk –Resources Used WEDI sequencing white paper as guidance Minimize changes to ‘core system’ processes
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Medicare FFS - Implementation Instructions Effort began almost two years ago JAD technique, involving our partners extensively Instructions contain: –Requirements –Flat file formats/crosswalks –Edit documents and other guidance
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Medicare FFS - Instructions Progress Published: –Inbound claim and outbound COB (837) –Remittance Advice (835) –Claims status query/response (276/277) –Testing In Progress: –Eligibility query/response (270/271) –Referral/authorization (278) –Retail Pharmacy (NCPDP)
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Medicare FFS - Status Medicare contractors using Claredi for testing and certification Testing with partners is sequenced by transaction: –Claim - began mid-April –Remittance Advice - mid-May –COB - mid-June –Claims Status - mid-July
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Medicare Managed Care Providing technical assistance and oversight Sponsoring conferences and training Transactions: –Will use 820 for premium payments –Plans will have the option of batch 270/271 or DDE for eligibility inquiries –Plans will have the option to use 837 to report risk adjustment data to CMS (this transaction does not require a HIPAA standard)
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State Medicaid Programs Providing technical assistance and oversight Developed a HIPAA compliance “road map” for States –CD-based tool –Provides gap analysis, resources Facilitating cooperative working relationships among States to identify issues
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CMS Outreach Tremendous effort to reach entire health care industry - not just Medicare and Medicaid Providers Website Periodic satellite broadcasts and video tapes Industry roundtable conference calls Participation in major industry conferences We are challenged to reach everyone...
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