New Rules Simplify Healthcare Paperwork
- By BSTQ Staff
The U.S. Department of Health and Human Services has published a new rule for electronic funds transfers in healthcare that calls for simplified standards to be implemented for the format and data content of the transmission a health plan sends to its bank when it wants to pay a claim to a provider electronically and to issue a Remittance Advice notice.
The new rule, which became effective January 1 and must be complied with by all health plans covered under HIPAA by Jan. 1, 2014, will offer increased standardization of information and transmission formats so that healthcare providers can use one type of information request for all insurers rather than being required to use multiple systems. For instance, if a doctor submits an electronic analysis to a health plan regarding a patient’s eligibility, certain plans may reply only yes or no, while others offer information that the physician needs to know at the point of service such as deductibles and patient copays. Under this rule, physicians will receive a more comprehensive response when they inquire about the status of a claim they have submitted.
Future administrative simplification rules will include a standard unique identifier for health plans, a standard for claims attachments, and requirements that health plans certify compliance with all HIPAA standards and operating rules.
According to an April 2010 study in Health Affairs, “Physicians spend nearly 12 percent of every dollar they receive from patients to cover the costs of filling out forms and performing other excessively complex administrative tasks. The study found that simplifying these systems could save four hours per week of professional time per physician and free up hours of support staff time every week — time that could be better spent on patient care.”
The implementation of this rule and the HIPAA rule are projected to save the healthcare industry more than $16 billion over the next 10 years.