The Centers for Medicare & Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) announced today in its HIPAA Administrative Simplification Information Bulletin that, based on findings from an recently completed Optimization Pilot study, it will start in April random audits of covered entity health plans and clearinghouses to ensure compliance with HIPAA Administrative Simplification requirements for electronic healthcare transaction formats, code sets, and unique identifiers. The audit program will supplement CMS’s existing complaint-based approach to enforcing standards and voluntary testing program to assess compliance. Participants in these programs will attest to compliance with operating rules, have an opportunity to make corrections, as necessary, or face “escalated enforcement actions” with failure to do so. In 2019, CMS will initiate a similar pilot program for healthcare providers. Download the March 25, 2019, Bulletin for more information on the audit program, and the March 22, 2019, Bulletin for information on the Optimization Pilot results.

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