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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. CMS’s Commitment to Implementing HIPAA. Office of Operations Management New - PowerPoint PPT Presentation
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Implementing HIPAACenters for Medicare & Medicaid Services
Fourth National HIPAA SummitApril 25, 2002
Jared A. Adair
Director
Office of Operations Management
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
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
Medicare Fee-for-Service
• CMS directly responsible for readiness
• Business partners– Medicare carriers and fiscal intermediaries– Claims processing systems maintainers
• Environment: Quarterly systems releases
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
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
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)
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
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)
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
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...