HHS Issues New Rules for Electronic Claim Payments, Saving $9B | Healthcare Informatics Magazine | Health IT | Information Technology Skip to content Skip to navigation

HHS Issues New Rules for Electronic Claim Payments, Saving $9B

August 8, 2012
by Jennifer Prestigiacomo
| Reprints

Health and Human Services (HHS) Secretary Kathleen Sebelius announced today the release of a new rule that will cut red tape for doctors, hospitals, and health plans. In combination with a previously issued regulation, the rule will save up to $9 billion over the next ten years. The regulation adopts operating rules for making health care claim payments electronically and describing adjustments to claim payments.

“These new rules will cut red tape, save money and ensure doctors spend more time seeing patients and less time filling out forms,” said Secretary Sebelius.

Studies have found that the average physician spends three weeks a year on billing and insurance related tasks, and, in a physician’s office, two-thirds of a full-time employee per physician is necessary to conduct these tasks. Many physician practices and hospitals receive and deposit paper checks, and manually post and reconcile the health care claim payments in their accounting systems. By receiving payments electronically and automating the posting of the payments, a physician practice and hospital’s administrative time and costs can be decreased.

The operating rules build upon industry-wide health care electronic fund transfer (EFT) standards that HHS adopted in January of this year. Together, the previously issued EFT standards and the EFT and electronic remittance advice (ERA) operating rules announced today are projected to save between $2.7 billion and more than $9 billion in administrative costs over ten years by reducing inefficient manual administrative processes for physician practices, hospitals, and health plans.

Operating rules include best business practices on how electronic transactions are transmitted and often target obstacles that physician practices and health insurers have with using electronic transactions. For instance, the rule announced today requires insurers to offer a standardized, online enrollment for EFT and ERA so that physicians and hospitals can more easily enroll with multiple health plans to receive those transactions electronically. The rule also requires health plans to send the EFT within a certain amount of days of the ERA, which helps providers reconcile their accounts more quickly.

Today’s rule, Administrative Simplification: Adoption of Operating Rules for Health Care Electronic Funds Transfers (EFT) and Remittance Advice Transactions were developed through extensive discussions with industry stakeholders. The rule adopts the Council for Affordable Quality Healthcare's Committee on Operating Rules for Information Exchange (CAQH CORE) Phase III EFT & ERA Operating Rule Set, including the CORE v5010 Master Companion Guide Template, with the exception of Requirement 4.2 of the Phase III CORE 350 Health Care Claim Payment/Advice (835) Infrastructure Rule. Collectively, these rules are referred to as the EFT & ERA Operating Rule Set.

The regulation announced today may be viewed at www.ofr.gov/inspection.aspx and will be effective upon its publication in the Federal Register on Aug. 10, 2012. The comment period closes on Oct. 9, 2012.

The compliance date for operating rules for the health care electronic funds transfers and remittance advice transaction is Jan. 1, 2014.

A fact sheet with technical information on the rule is found at .
 

Topics

News

Former Health IT Head in San Diego County Charged with Defrauding Provider out of $800K

The ex-health IT director at North County Health Services, a San Diego County-based healthcare service provider, has been charged with spearheading fraudulent operations that cost the organization $800,000.

Allscripts Touts 1 Billion API Shares in 2017

Officials from Chicago-based health IT vendor Allscripts have attested that the company has reached a new milestone— one billion application programming interface (API) data exchange transactions in 2017.

Dignity Health, CHI Merging to Form New Catholic Health System

Catholic Health Initiatives (CHI), based in Englewood, Colorado, and San Francisco-based Dignity Health officially announced they are merging and have signed a definitive agreement to combine ministries and create a new, nonprofit Catholic health system.

HHS Announces Winning Solutions in Opioid Code-a-Thon

The U.S. Department of Health and Human Services (HHS) hosted this week a first-of-its-kind two-day Code-a-Thon to use data and technology to develop new solutions to address the opioid epidemic.

In GAO Report, More Concern over VA VistA Modernization Project

A recent Government Accountability Office (GAO) report is calling into question the more than $1 billion that has been spent to modernize the Department of Veterans Affairs' (VA) health IT system.

Lawmakers Introduce Legislation Aimed at Improving Medicare ACO Program

U.S. Representatives Peter Welch (D-VT) and Rep. Diane Black (R-TN) have introduced H.R. 4580, the ACO Improvement Act of 2017 that makes changes to the Medicare accountable care organization (ACO) program.