hipaa!An article posted yesterday on the Health Data Management website reveals that a number of health insurers are not in compliance with HIPAA transaction rules. The Medical Group Management Association (MGMA) believes the Centers for Medicare and Medicaid Services (CMS) need to up the ante when it comes to enforcing these rules.

The insurance plans, which consist of regional and national plus a few government health plans, are informing providers wishing to conduct electronic HIPAA transactions that the transactions are unsupported, a HIPAA Act violation. These ignored transactions include but are not limited to claims status, referral authorization, and electronic claims.

Providers wishing to conduct electronic transactions face several hurdles. For example, they may file an electronic complaint to CMS regarding the insurer by using the HIPAA Administrative Simplification Complaint Form. However, that information may be displayed in a Freedom of Information Act request which could be accessed by the health plan, allowing them to identify the provider. This opens the door to potential provider auditing retaliation.

MGMA believes CMS has the power to take action when it comes to HIPAA transaction usage for payers. For instance, CMS may audit payers based on their standards adherence and then take stronger measures to fine them should they violate the rules.

To read more, please visit https://www.healthdatamanagement.com/news/mgma-asks-cms-to-enforce-hipaa-compliance-rules-on-health-insurers.

This update is by Medical Accounts Systems, a full-service healthcare revenue cycle management company providing a number of services including insurance follow up and managed care disputes, physician reimbursement, hospital extended business office services, and more. For additional information on our services or for any questions you may have on topics such as medical debt collection, please call 877-759-6315.