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In addition to these programs, CMS has other responsibilities, including the administrative simplification standards from the Health Insurance Portability and Accountability Act of 1996 (HIPAA), quality standards in long-term care facilities (more commonly referred to as nursing homes) through its survey and certification process, clinical ...
Details are contained in a CMS document entitled, "Guidance on Compliance with the HIPAA National Provider Identifier (NPI) Rule." Small health plans have one additional year to comply. All individual HIPAA–covered healthcare providers or organizations must obtain an NPI for use in all HIPAA standard transactions, even if a billing agency ...
Under HIPAA, HIPAA-covered health plans are now required to use standardized HIPAA electronic transactions. See, 42 USC § 1320d-2 and 45 CFR Part 162. Information about this can be found in the final rule for HIPAA electronic transaction standards (74 Fed. Reg. 3296, published in the Federal Register on January 16, 2009), and on the CMS website.
In 2020, the U.S. Centers for Medicare & Medicaid Services (CMS) issued their Interoperability and Patient Access final rule, (CMS-9115-F), based on the 21st Century Cures Act. The rule requires the use of FHIR by a variety of CMS-regulated payers, including Medicare Advantage organizations, state Medicaid programs, and qualified health plans ...
Title IV of the act promises maximum incentive payments for Medicaid to those who adopt and use "certified EHRs" of $63,750 over 6 years beginning in 2011. Eligible professionals must begin receiving payments by 2016 to qualify for the program. For Medicare, the maximum payments are $44,000 over 5 years.
In November 1991, the Workgroup for Electronic Data Interchange (WEDI) was established in response to the challenge from the Bush administration, specifically, Louis Sullivan MD, Secretary of HHS, to reduce administrative costs in the nation's health care system by up to 10%.
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