Medicare Compliance & Reimbursement

Plus: The MAC Satisfaction Indicator survey is back.

If you weren’t keen on the HIPAA phase two audits, prepare yourself. Because now, CMS has decided to get in on the fun. The agency has added yet another compliance program to its e-health renaissance — this time with a HIPAA-edge.

Background: The CMS Division of National Standards has launched a “Compliance Review Program,” which in a nutshell means more HIPAA audits, the agency indicated in a provider message. Starting sometime this April, the feds will randomly select nine HIPAA-covered entities (CEs) and review their electronic health transactions, ensuring HIPAA Administrative Simplification rule alignment.

For this first audit junket, the CEs will be a mix of health plans and clearinghouses. The new review system builds on a pilot program that HHS initiated in 2018 and is meant to be a “proactive approach” to compliance.

Wait for it: But just because providers aren’t in the first round doesn’t mean they won’t be in the future. In fact, providers’ can expect random audits on the horizon later this year. “In 2019, providers will be able to participate in a separate pilot program on a voluntary basis,” CMS says.

See the CMS “Compliance Review Program” release at www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/Enforcements/Compliance-Review-Program.html.

In other news…

Don’t hold back on what you think of your Medicare carrier, CMS says.

The agency is once again running its MAC Satisfaction Indicator survey, which “is designed to measure your satisfaction as a Medicare provider with the performance of your Medicare Administrative Contractor [MAC],” explains CMS in a provider message.

However, you can’t just vent your frustration, CMS stresses. The MSI is specifically for providers to offer feedback on their MACs.

“The MSI will not measure your satisfaction with other Medicare contractor types such as … Recovery Audit Contractors (RACs), Comprehensive Error Rate Testing (CERT) contractors, Zone Program Integrity Contractors (ZPICs), Supplemental Medical Review Contractors (SMRCs) or Qualified Independent Contractors (QICs),” CMS says.

“The MSI survey is only offered on an annual basis, for a specified window of time, so don’t miss your chance to be heard,” reminds MAC Palmetto GBA.

Find your MAC link and read past results at www.cms.gov/Medicare/Medicare-Contracting/MSI/.