CMS Introduces New Interoperability Framework with HITRUST Certification

Very interesting insights from CMS - highlighting HITRUST Certification as an element of their Interoperability Framework. While not a mandate, it is clear that the road to health interoperability includes trust. If you have questions related to HITRUST please reach out!

The Centers for Medicare & Medicaid Services (CMS) raised the bar for health data exchange with its new Interoperability Framework that requires validation equivalent to HITRUST certification — a clear signal that secure, trusted interoperability is non-negotiable. HITRUST isn’t just another compliance checkbox. It’s the gold standard for healthcare security. Read more about how HITRUST supports CMS’s vision for trusted interoperability. https://lnkd.in/g-eBhpEz #HealthcareSecurity #CMSInteroperability #SecurityFramework #HealthcareCompliance

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Exploring Top Healthcare Technology Trends While Ensuring HIPAA Compliance The healthcare industry is undergoing a remarkable shift, driven by rapid advancements in technology. Innovations are enhancing patient care, streamlining operations, and improving data management. Yet, amid this transformation, maintaining HIPAA compliance is essential. This post will delve into the top healthcare technology trends that are shaping the industry today while stressing the critical need for adherence to HIPAA regulations. #linkedin https://lnkd.in/gKSaMdZG

Navigating Emerging Technologies in Healthcare While Ensuring HIPAA Compliance The healthcare landscape is rapidly changing due to exciting new technologies. From virtual doctor visits to advanced data analytics, innovations promise to enhance patient care and streamline operations. However, these developments come with serious responsibilities, particularly when it comes to protecting patient information under HIPAA regulations. This article dives into the world of emerging technologies in healthcare and highlights how to stay compliant with HIPAA to safeguard patient data. #linkedin Want to read more? Subscribe to mljconsultancy.net to keep reading this exclusive post. https://lnkd.in/gcUcbFgH

CMS just rolled out its new Interoperability Framework to make it easier for patients, providers, and payers to share data. Big names like Epic, Apple, and Google are already on board. This is a huge step forward for healthcare, but with more data moving between systems, the need for strong security and compliance is higher than ever. That’s why the framework also requires HITRUST, making organizations prove they can be trusted with sensitive health data. This will likely drive many more companies to pursue HITRUST certification in the months ahead. https://lnkd.in/eTZ_Pgi5 #Healthcare #HITRUST #Compliance #Interoperability

Did you know that in 2023 alone, over 133 million Americans had their healthcare data compromised due to breaches? In medical billing, speed and accuracy often get the spotlight but behind the scenes, two silent guardians ensure everything runs smoothly i.e. HIPAA Compliance and Billing Compliance. Without them, providers risk not only lost revenue, but also reputational damage and legal penalties. The Case for HIPAA Compliance: - The Ponemon Institute estimates the average cost of a healthcare data breach at $10.93 million - the highest of any industry. - Beyond dollars, breaches erode the trust patients place in providers. - HIPAA safeguards Protected Health Information (PHI), ensuring confidentiality at every step of the billing cycle. The Case for Billing Compliance - According to Centers for Medicare & Medicaid Services (CMS), improper Medicare payments reached $31.2 billion in 2022, largely due to coding errors and non-compliant billing practices. - OIG audits can impose penalties of up to $25,000 per violation and even bar providers from federal programs. - Billing compliance reduces denials, secures timely reimbursements, and protects providers from regulatory risk. The Intersection of HIPAA & Billing Compliance When combined, HIPAA and billing compliance form the backbone of ethical, efficient medical billing operations: - HIPAA protects patient data during the billing cycle. - Billing compliance ensures claims are accurate, justified, and audit-ready. - Together, they minimize risk, protect revenue, and strengthen patient-provider relationships. Key Takeaways for Providers & Billing Companies - Invest in staff training on HIPAA and compliance updates. - Conduct regular internal audits to identify gaps early. - Leverage secure technology that encrypts PHI and supports accurate coding. - Treat compliance not as a cost, but as an investment in sustainability and trust. Our Commitment at RCM Plus BPO At RCM Plus BPO, we understand that compliance is not optional, it is the foundation of trustworthy medical billing. That’s why we embed HIPAA and billing compliance into every process we manage. From secure handling of patient information to rigorous claim accuracy checks, we take compliance as seriously as providers take patient care. Because for us, compliance isn’t just about avoiding penalties, it’s about protecting lives, trust, and revenue. #MedicalBilling #HIPAACompliance #BillingCompliance #HealthcareRevenueCycle #HealthcareFinance #MedicalBillingServices #HealthcareCompliance #RevenueCycleManagement #HealthcareBusiness #RCM

CMS has published its new Interoperability Framework, a voluntary blueprint aimed at modernizing health data exchange. The framework focuses on patient empowerment, data availability, and security, encouraging the use of FHIR APIs and emphasizing transparency and secure data sharing, including the use of validations like HITRUST certification. It's designed to be a market-friendly approach to help health data networks operate more efficiently without creating new regulatory burdens. The framework is built upon five foundational pillars, each containing specific criteria for participants. I. Patient Access & Empowerment II. Provider Access & Delegation III. Data Availability & Standards Compliance IV. Network Connectivity & Transparency V. Identity, Security & Trust This is a great step forward for the industry, pushing us closer to a more connected and patient-centric health ecosystem. Read more about the framework here: https://lnkd.in/gS8ru9zq #healthcare #interoperability #CMS #FHIR #healthtech #HITRUST

Is your EHR ONC-certified? It should be. As a certified EHR, PIMSY has completed the rigorous, voluntary ONC Health IT Certification process because compliance, security, and trust are essential. Certification demonstrates that PIMSY meets federal standards for interoperability, privacy, and security, allowing you to focus on care without compliance concerns. If your organization participates in Medicare, Medicaid, QPP, MIPS, or HIEs, an ONC-certified EHR isn't just a best practice—it's a requirement. When it comes to patient data and regulatory requirements, don't take chances. Choose certified. Stay compliant. Be secure. #ONCCertification #HealthIT #Compliance #BehavioralHealth #Interoperability #HIPAA #EHR #PIMSY

CMS has announced a major expansion of Risk Adjustment Data Validation (RADV) audits for Medicare Advantage plans, with a sharp focus on billing accuracy and compliance. 𝗛𝗲𝗿𝗲’𝘀 𝗪𝗵𝗮𝘁’𝘀 𝗖𝗵𝗮𝗻𝗴𝗶𝗻𝗴: 𝗔𝗹𝗹 𝗣𝗹𝗮𝗻𝘀 𝗔𝘂𝗱𝗶𝘁𝗲𝗱: Every Medicare Advantage contract will now face an annual audit. 𝗔𝘂𝗱𝗶𝘁 𝗩𝗼𝗹𝘂𝗺𝗲 𝗜𝗻𝗰𝗿𝗲𝗮𝘀𝗲𝗱: From ~60 plans per year to all 550 eligible plans. 𝗠𝗼𝗿𝗲 𝗥𝗲𝗰𝗼𝗿𝗱𝘀 𝗖𝗵𝗲𝗰𝗸𝗲𝗱: Reviews rising from 35 to 200 per plan, depending on size. 𝗪𝗼𝗿𝗸𝗳𝗼𝗿𝗰𝗲 𝗚𝗿𝗼𝘄𝘁𝗵: CMS is expanding its coding team from 40 to 2,000 coders by September 2025. 𝗪𝗵𝘆 𝗶𝘁 𝗠𝗮𝘁𝘁𝗲𝗿𝘀 𝘁𝗼 𝗣𝗿𝗼𝘃𝗶𝗱𝗲𝗿𝘀: These expanded audits mean greater scrutiny of documentation and coding practices. Unsupported diagnoses can lead to claim denials, recoupments, and compliance risks for providers tied to Medicare Advantage plans. At CloudRCM Solutions, we help healthcare providers keep their documentation and coding audit-ready, ensuring smooth and compliant workflows. 𝗖𝗼𝗻𝘁𝗮𝗰𝘁 𝘂𝘀 𝘁𝗼𝗱𝗮𝘆 𝗮𝗻𝗱 𝗸𝗲𝗲𝗽 𝘆𝗼𝘂𝗿 𝗽𝗿𝗮𝗰𝘁𝗶𝗰𝗲 𝗽𝗿𝗼𝘁𝗲𝗰𝘁𝗲𝗱! 📞 +1 (224) 231-6880 🌐 www.cloudrcmsolutions.com ✉️ hello@cloudrcmsolutions.com #CloudRCMSolutions #CMSAudits #HealthcareUSA #MedicareAdvantage #MedicalBilling #HealthcareRCM