Nearly one in five doctors surveyed in a recent MGMA (Medical Group Management Association) Stat poll reported that their electronic funds transfer (EFT) payments from health plans come with a fee.
As explained by MGMA, typically, physician practices in the past would receive a paper check from a health plan for payment of a medical service. In 2012, the Centers for Medicare & Medicaid Services (CMS) established a standard for the electronic funds transfer and supporting operating rules.
But as Robert Tennant, director of health IT policy, MGMA, noted, “Some health plans and their contracted payment vendors have sought to take advantage of physician practices by forcing them to pay fees to receive their payments for medical services via EFT. These transaction fees typically range from 2 to 5 percent of the total medical services payment.”
According to MGMA’s September poll, 17 percent of respondents indicated that their EFT payments from health plans came with a fee, with 50 percent saying there was no fee attached to the transaction. More than 32 percent indicated that they were unsure. Of those who responded yes to receiving fees for EFT payments, almost 60 percent stated that these health plans use a third-party payment vendor. “Providers are forced to pay these EFT fees as CMS has yet to issue explicit guidance against health plans and payment vendors charging these tolls,” noted MGMA’s Tennant.
For practices, the most common savings are in the ability to automate the re-association of the electronic payment with the electronic remittance advice (ERA), as well as savings in staff time to process and deposit paper checks manually.
“Even though health plans save money not printing and mailing paper checks, some bad actors are fleecing physician groups by charging them to simply receive an electronic paycheck,” Anders Gilberg, MGMA senior vice president, government affairs, said in a statement. “It is critical that CMS issue long-overdue guidance explicitly prohibiting this practice.”
MGMA said that it has been, along with other provider organizations, advocating that CMS release regulatory guidance relating to EFT operating rules. “Once that guidance is in place and physician practices are no longer subject to unreasonable fees, we believe provider adoption of the EFT transaction will increase,” officials said.