Operating rules expected to cut red tape for physicians and hospitals

The U.S. Department of Health & Human Services (HHS) on Aug. 7 released operating rules for making healthcare claim payments electronically and describing adjustments to claim payments. The department expects the rules to save up to $9 billion over the next 10 years.

“These new rules will cut red tape, save money and ensure doctors spend more time seeing patients and less time filling out forms,” said HHS Secretary Kathleen 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," a prepared statement from HHS said.

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 Aug. 7 are projected to generate savings in administrative costs 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 newly announced rule 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.

HHS said 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.

Click here to view the new regulation. It will become 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 healthcare EFT and remittance advice transaction is Jan. 1, 2014.

Technical information can be found in a fact sheet available here.


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