HIPAA Final Rule: Enforcement: Four Penalty Tiers

February 21, 2013.  Today, we examine the four penalty tiers for violations of HIPAA Rules in the Final Rule:  Modifications to the HIPAA Privacy, Security, Enforcement, and Breach Notification Rules Under the Health Information Technology for Economic and Clinical Health Act [HITECH Act] and the Genetic Information Nondiscrimination Act; Other Modifications of the HIPAA Rules, which was published in the Federal Register on January 25, 2013.  The effective date of the Final Rule is March 26, 2013, and covered entities and business associates must comply by September 23, 2013. We start with two definitions, the first of which, Reasonable cause, was modified in the Final Rule, and the second of…

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Final Administrative Simplification Rules for Plan ID, NPI Addition, and ICD-10 Code Set Compliance Delay Published in Federal Register

September 5, 2012.  Today, the Federal Register published the Centers for Medicare & Medicaid Services (CMS) Final Rule:  Administrative Simplification:  Adoption of a Standard for a Unique Health Plan Identifier; Addition to the National Provider Identifier [NPI] Requirements; and a Change to the Compliance Date for the International Classification of Diseases, 10th Edition (ICD-10-CM and ICD-10-PCS) Medical Data Code Sets.  We provided the detailed “Executive Summary” in our August 24, 2012, posting, based on the preview posting at the Federal Register’s Electronic Public Inspection Desk.  Below we provide the shorter publication “Summary” [p.54664]: “This final rule adopts the standard for a national unique health plan identifier (HPID) and establishes requirements…

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CMS Issues Final Administrative Simplification Final Rules Regarding Identifiers and ICD-10 Code Set Compliance Delay

August 24, 2012.  Today, the Office of Management and Budget (OMB) completed review and sent to the Federal Register for publication on September 5, 2012, the Centers for Medicare & Medicaid Services (CMS) Final Rule:  Administrative Simplification:  Adoption of a Standard for a Unique Health Plan Identifier; Addition to the National Provider Identifier Requirements; and a Change to the Compliance Date for the International Classification of Diseases, 10th Edition (ICD-10-CM and ICD-10-PCS) Medical Data Code Sets.  The effective date of the Rule is November 5, 2012.  Prior to publication, the Final Rule may be examined at or downloaded from the Office of the Federal Register’s Electronic Public Inspection Desk. Here…

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EFT and RA Transaction Operating Rules IFC Published in Federal Register August 10

August 10, 2012.  Today, the Interim Final Rule with comment period (IFC):  Administrative Simplification:  Adoption of Operating Rules for Electronic Funds Transfers (EFT) and Remittance Advice Transactions, was published in the Federal Register.  The effective date of the IFC is the date of publication, August 10, 2012.   Comments on the IFC may be submitted to the Department of Health and Human Services (HHS) on or before October 9, 2012, with submission instructions included on page 48008 of the IFC.    The Executive Summary (without footnotes) from the IFC follows: “A.  Purpose of the Regulatory Action.  Health care spending in the United States constitutes nearly 18 percent of the US…

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HHS Publishes NPRM for HIPAA Health Plan Identifier and Delay for ICD-10 Compliance Date

April 17, 2012.  The Office of the Secretary of the Department of Health and Human Services (HHS) published today in the Federal Register its Notice of Proposed Rule Making (NPRM):  Administrative Simplification:  Adoption of a Standard for a Unique Health Plan Identifier; Addition to the National Provider Identifier Requirements; and a Change to the Compliance Date for ICD-10-CM and (CD-10-PCS Medical Data Code Sets. From the NPRM is the Summary of the Major Provisions: “a. HPID.  This rule proposes the adoption of the HPID [national unique health plan identifier] as the standard for the unique identifier for health plans and definitions for ‘Controlling Health Plan’ and ‘Subhealth Plan.’ The proposed…

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HHS Issues HIPAA NPRM for Unique Health Plan Identifier and One Year Delay for ICD-10 Code Set Compliance

April 10, 2012.  Yesterday, the Office of the Secretary of the Department of Health and Human Services (HHS) promulgated a notice of proposed rule making (NPRM) entitled:  Administrative Simplification:  Adoption of a Standard for a Unique Health Plan Identifier; Addition to the National Provider Identifier Requirements; and a Change to the Compliance Date for ICD-10-CM and ICD-10-PCS Medical Data Code Sets. The NPRM will be published in the Federal Register on April 17, 2012. Here is the NPRM summary:  “This proposed rule would implement section 1104 of the Patient Protection and Affordable Care Act (hereinafter referred to as the Affordable Care Act) by establishing new requirements for administrative transactions that…

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IFR for HIPAA EFT Standard to be Published in Federal Register January 10, 2012

HIPAA.com discussed in its preceding posting this Interim Final Rule (IFR) for “adoption of standards and operating rules for Electronic Funds Transfers (EFT) and operating rules for remittance advice…”, as required by the Patient Protection and Affordable Care Act of 2010 (Public Law 111-148).  [124 STAT. 153] The Office of Management and Budget (OMB) completed its regulatory review on January 3, 2012, and the IFR is available for pre-publication review prior to January 10, 2012, when it will be published in the Federal Register.  The title of the IFR is: Administrative Simplification:  Adoption of Standards for Health Care Electronic Funds Transfers (EFTs) and Remittance Advice. The Summary in the pre-publication…

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IFR for EFT at OMB

The Centers for Medicare & Medicaid Services (CMS) of the Department of Health and Human Services (HHS) has sent to the Office of Management and Budget (OMB) its Interim Final Rule (IFR) for “adoption of standards and operating rules for Electronic Funds Transfers (EFT) and operating rules for remittance advice….” Following the December 15 receipt and subsequent review of the IFR by OMB, the IFR is expected to be published in the Federal Register before January 1, 2012, as required by the Affordable Care Act of 2010 (Public Law 111-148). [124 STAT. 153] The legal authority for the IFR is Section 1104 (Administrative Simplification) of the Affordable Care Act.  Section 1104…

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CMS Initiates 90-Day Enforcement Discretion for 5010 Compliance

January 1, 2012, is the date for covered entities to achieve compliance with ASC X12 Version 5010, NCPDP Telecom D.0, and NCPDP Medicaid Subrogation 3.0 transaction standards. Covered entities include healthcare providers, health plans, and healthcare clearinghouses. Small health plans have until January 1, 2013, to comply with the NCPDP Medicaid Subrogation 3.0 standard. The Center for Medicare & Medicaid Services (CMS) Office of E-Health Standards and Services (OESS) is responsible for enforcement of compliance with electronic transaction standards.  CMS announced on November 17, 2011, that “[w]hile enforcement action will not be taken [from January 1-March 31, 2012], OESS will continue to accept complaints associated with compliance with Version 5010,…

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CMS Confirms 5010 and ICD-10 Rules’ Effective Dates

In notification to the U.S. House and Senate on Thursday, March 5, 2009, Don Johnson, Acting Director, Office of Legislation of the Centers for Medicare & Medicaid Services (CMS), notified the Congress that “[i]n accordance with the White House Chief of Staff’s memorandum of January 20, 2009 entitled ‘Regulatory Review,’ a determination has been made that the effective date will not be extended and the comment period will not be reopened for either of these rules.” The effective date for each of the rules is March 17, 2009. The memorandum CMS sent to Congress follows. Beginning next Monday, March 9, HIPAA.com will have a posting daily through March 17, 2009,…

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