Insurer - Healthcare Provider Electronic Transfer Rule Comment Period Closes Tomorrow

Healthcare provider organizations such as the American Hospital Association and American Medical Association have thrown their support behind a proposed rule by the Centers for Medicare and Medicaid Services (CMS) regarding electronic standards and transactions between insurers and providers.

Comments on the proposed rule, which can be downloaded here, close tomorrow.

The rule, called “Administrative Simplification: Adoption of Operating Rules for Health Care Electronic Funds Transfers (EFT) and Remittance Advice Transactions,” is part of the Administrative Simplification provisions under the Affordable Care Act of 2010 (ACA). In August the Secretary of Health and Human Services (HHS) published the new rule, which becomes effective Jan. 1, 2014, and establishes standards for EFTs and health care payment and electronic remittance advice (ERA).

By creating data standards for EFTs, ERAs, and for insurers, healthcare providers and their financial institutions can reduce and even eliminate what currently are paper-based payment systems and manual business processes. With data standards in place, payment systems between insurers, providers, and financial institutions can better communicate and process transactions electronically.

While the AMA and AHA are supportive of the rule change, both organizations believe that it does not go far enough. According to the AHA, “CMS has called for the adoption of operating rules authored by the Committee on Operating Rules for Information Exchange (CORE),” but has yet to adopt all the CORE operating rules. “We urge CMS to quickly propose adoption of a standard acknowledgement transaction as part of the set of Health Insurance Portability and Accountability Act (HIPAA) transaction standards to clear the way for total adoption of CORE’s operating rules.” Likewise, the AMA wrote in its comments that the association is “disappointed that the associated acknowledgment transactions were not included in this rule.”

Comments on the proposed rule close tomorrow and can be delivered to CMS electronically, by mail, or by hand, by following the directions published in the Federal Register, which can be downloaded here.

To read the CMS press release on the new rule, click here.

To read the CMS Fact Sheet on the new rule, click here.