The Documentation-Coding Connection

CMS issues HIPAA checklist for providers

The Department of Health and Human Services' Centers for Medicare and Medicaid Services (CMS) has issued a checklist to help health care providers who do business electronically and their business partners to comply with the administrative simplification requirements of the Health Insurance Portability and Accountability Act (HIPAA).

Use standard format

HIPAA does not require a health care provider to conduct all transactions such as claims or equivalent encounter information, payment and remittance advice, claim status inquiry and response, eligibility inquiry and response, and referral authorization inquiry and response electronically. But any of these things that are done electronically must be done in the standard format outlined under HIPAA. Checklist items include:

  • Determine, as a health care provider, if you are covered by HIPAA because you conduct any of the typical transactions electronically.
  • Assign a HIPAA point person to handle the remaining checklist items, having that person educate others on the office staff.
  • Familiarize yourself with key HIPAA deadlines.
  • Determine that software is ready, find out what needs to be done to comply for all electronic transactions, ask vendors how and when they will be making HIPAA changes and document the response.

Talk to payers you bill to see what they are doing to prepare for HIPAA and ask for trading partner agreements that specify transmission methods, volumes, timelines, and coding and transaction requirements that are not specifically determined by HIPAA.