HHS issues new rules for docs, hospitals

HHS Secretary Kathleen Sebelius

The US Department of Health and Human Services (HHS) has issued new rules for making healthcare claim payments electronically and describing adjustments to claim payments.

The rules, which govern electronic fund transfer (EFT) and electronic remittance advice (ERA), are expected to reduce manual administrative processes at physician practices and hospitals, thereby saving time and money.

“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.

In fact, the Centers for Medicare & Medicaid Services estimate that the rules, called the EFT & ERA Operating Rule Set, will save the healthcare industry $3 billion to $4.5 billion over 10 years.

However, implementing the rules will cost government and commercial health plans, third party administrators, hospitals, and physician practices $1.2 billion to $2.7 billion over the next 10 years.

Costs aside, the rules will save time, according to the HHS. The EFT & ERA Operating Rule Set includes best business practices on how electronic transactions are transmitted. The rules also target obstacles that physician practices and health insurers may have with using electronic transactions.

For instance, the rules require insurers to offer a standardized, online enrollment for EFT and ERA so physicians and hospitals can more easily enroll with multiple health plans to receive those transactions electronically.

The rules also require health plans to send the EFT within a certain amount of days of the ERA, which helps providers reconcile their accounts more quickly.

The EFT & ERA Operating Rules will be effective upon their publication in the Federal Register on August 10, but they are open for comment until October 9.

At present, the rules can be viewed at http://www.ofr.gov/OFRUpload/OFRData/2012-19557_PI.pdf.

Discussion

Notify me when a comment is posted for this article