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…


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…


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,…


HHS Strengthens HIPAA Enforcement

On Friday, October 30, 2009, HHS published in the Federal Register its Interim Final Rule that strengthens HIPAA enforcement under HITECH Act civil penalty revisions enacted as part of the American Recovery and Reinvestment Act on February 17, 2009.  “These HITECH Act revisions significantly increase the penalty amounts the Secretary [of HHS] may impose for violations of the HIPAA rules and encourage prompt corrective action,” according to the HHS press release.  The Interim Final Rule is effective as federal policy on November 30, 2009, and HHS requests comments by December 29, 2009. With the definition of ‘breach’ in the HITECH Act moving privacy and security violations under one requirement requiring…


Are You Subject to HIPAA Privacy Rules when Publishing Confidential Health Information on a Social Network?

It’s unlikely the social networking sites are health care providers, so HIPAA’s privacy rule doesn’t apply; but other privacy business practices are likely to affect you. First, tackle the HIPAA Privacy question by responding to the following questions. » Are you a healthcare provider that conducts transactions electronically? » Are you a healthcare clearinghouse? (Do you process healthcare claims?) » Are you a health plan? (insurance payer) If you answered no to these questions, you are not a covered entity under HIPAA’s Privacy Rule. That said, you probably are more concerned about users sharing health information online that if stolen, could be used in identity theft. Consumers (patients) often use…


National Provider Identifier Final Rule

DEPARTMENT OF HEALTH AND HUMAN SERVICES Office of the Secretary 45 CFR Part 162 | [CMS–0045–F] | RIN 0938–AH99 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers AGENCY: Centers for Medicare & Medicaid Services, HHS. ACTION: Final rule. Download (Requires Acrobat Reader)

Employer Identifier Final Rule

DEPARTMENT OF HEALTH AND HUMAN SERVICES Office of the Secretary 45 CFR Parts 160 and 162 | [CMS–0047–F] | RIN 0938–AI59 Health Insurance Reform: Standard Unique Employer Identifier AGENCY: Centers for Medicare and Medicaid Services (CMS), HHS. ACTION: Final rule. Download (Requires Acrobat Reader)

Final Transactions Rule

DEPARTMENT OF HEALTH AND HUMAN SERVICES Office of the Secretary 45 CFR Parts 160 and 162 | [HCFA–0149–F] | RIN 0938–AI58 Health Insurance Reform: Standards for Electronic Transactions AGENCY: Office of the Secretary, HHS. ACTION: Final rule. Download (Requires Acrobat Reader)