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Diane Publishing Books
Health Information Technology: The Centers for Medicare and Medicaid Services (CMS) Took Steps to Improve Its Beneficiary Eligibility Verification System
Valerie C. Melvin (au)
Medicare is a federal program that pays for health care services for individuals 65 years and older and certain individuals with disabilities. In 2011, Medicare covered about 48.4 million of these individuals, and total expenditures for this coverage were approx. $565 billion. The Centers for Medicare and Medicaid Services (CMS), the agency within the Dept. of Health and Human Services (HHS) that administers Medicare, is responsible for ensuring that proper payments are made on behalf of the programäó»s beneficiaries. In response to the Health Insurance Portability and Accountability Act of 1996 (HIPAA) requirements, CMS developed and implemented an info. tech. (IT) system to help providers determine beneficiariesäó» eligibility for Medicare coverage. In May 2005 CMS began offering automated services through the HIPAA Eligibility Transaction System (HETS), which provides data to users about Medicare beneficiaries and their eligibility to receive payment for health care services and supplies. This report (1) identifies the operational status of HETS; (2) identifies any steps CMS has taken to ensure usersäó» satisfaction and plans to take to ensure the system supports future requirements; and (3) describes CMSäó»s policies, processes, and procedures for protecting the privacy of data provided by HETS. Tables. This is a print on demand report.
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