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Health Plans Take Notice: Compliance with HIPAA Administrative Simplification Rules is still Required

hipaa administrative simplification rulesOn Jan. 2, 2014, the Department of Health and Human Services (“HHS”) issued a proposed rule related to the Administrative Simplification requirements of the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”).  Specifically, it delayed the date by which health plans must certify compliance with certain operating rules imposed by the Affordable Care Act (“ACA”).   

The ACA required the Secretary of HHS to adopt operating rules related to claims status, eligibility, electronic funds transfers ("EFT") and health care payment and remittance advice transactions ("ERA").  Health plans (and other covered entities) were required to comply with the claims status and eligibility operating rules by Jan. 1, 2013 and the EFT and ERA operating rules by Jan. 1, 2014.  Additionally, health plans were required to file a statement with HHS certifying that the health plan is in compliance with the operating rules.  This certification statement was due by Dec. 31, 2013. 

The recently published proposed rule delayed the deadline for submission of this certification statement until Dec. 31, 2015. This delay is intended to provide more time for health plans to gather data that is required as part of the certification. The proposed rule makes it very clear that the deadlines for compliance with the operating rules were not affected.  Therefore, despite the reprieve from the certification deadline, a health plan is still required to comply with the operating rules.  If it fails to do so, it runs the risk of being assessed penalties.

If you have any questions about how the HIPAA Administrative Simplification rules may affect your health plan, please contact Mindi Johnson at mjohnson@fosterswift.com or 616.726.2252.

Categories: Billing/Payment, Compliance, Health Care Reform, HIPAA, Insurance, Privacy, Providers

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With a business-minded approach, and service-oriented delivery, Mindi helps clients navigate challenges and solve problems in the areas of employee benefits law and health care law. Mindi has spoken and written extensively on employee benefits, health care reform, and health care law topics, and is actively involved in a number of legal, professional and industry organizations focused on these issues.

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Best Lawyers® 2021

Congratulations to the attorneys of the Health Care practice group at Foster Swift Collins & Smith, PC for their inclusion in the Best Lawyers in America 2021 edition. Firm-wide, 44 lawyers were listed. Best Lawyers lists are compiled based on an exhaustive peer-review evaluation and as lawyers are not required or allowed to pay a fee to be listed; inclusion in Best Lawyers is considered a singular honor. Health Care practice group members listed in Best Lawyers are as follows:

To see the full list of Foster Swift attorneys listed in Best Lawyers 2021, click here.