The HIPAA Privacy and Security Rules have been in force for many years. In the past few years, however, health care industry has had to cope with extensions to HIPAA, as well as new EDI and diagnostic code standards.

Failure to meet some of the deadlines for compliance, particularly for ICD-10, can have real business impacts in terms of lost revenue, and inability to bill for Medicare work.

Healthcare providers require automated approaches that can streamline compliance programs. With BenchMark, which contains optimized workflows, pre-built assessment questionnaires and reports, and bundled professional services, Avior is providing tailored solutions for providers that ensures quick deployment, and rapid realization of value.

Avior’s deep experience with healthcare providers has enabled us to create solutions that automate the program management for ICD-10. Avior’s solutions for healthcare providers enable organizations to more effectively manage compliance to a complex set of new regulations:

Health Insurance Portability and Accountability Act (HIPAA) CMS requires a new EDI standard for all insurance and Medicare transactions as of January 1, 2012 and new, expanded diagnostics codes by October 1, 2014. Providers must ensure that every affiliate who submits claims (and other transactions) comply and are compatible.  Failure to comply will result in significant lost revenue.

Health Information Technology for Economic and Clinical Health Act (HITECH Act) extends the Privacy and Security Provisions of HIPAA to business associates of covered entities. This includes the extension of newly updated civil and criminal penalties to business associates. Healthcare providers must now monitor their vendors and other business associates for compliance. HITECH provisions include data breach notification requirements for healthcare data breaches.

Centers for Medicare and Medicaid Services (CMS) Security Audits require regulated entities to conduct formal assessments of the security of HIPAA regulated data including affiliates, vendors and other business associates.

Corporate Integrity Agreements are imposed by the Health and Human Services (HHS) as negotiated compliance obligations with health care providers, life science companies and other entities as part of the settlement of Federal health care program investigations arising under a variety of civil statutes. A provider or entity consents to these obligations as part of the civil settlement and in exchange for HHS’s agreement not to seek an exclusion of that health care provider or entity from participation in Medicare, Medicaid and other Federal health care programs.