The federal government Thursday issued a final interim "Red Tape" rule requiring health plans, healthcare clearinghouses, and certain healthcare providers to follow certain rules for electronic transactions designed to eliminate manual processes.
The rule is expected to save an estimated $12 billion over the next 10 years from improved electronic systems.
"Doctors and health insurance companies waste thousands of hours and billions of dollars filling out forms and processing paperwork," said Health and Human Services Secretary Kathleen Sebelius in a prepared statement. "The Affordable Care Act is helping doctors operate more efficiently and spend their time treating patients, not filing out papers."
Added Donald Berwick, MD, Administrator for the Centers for Medicare & Medicaid Services, "as a pediatrician, I know how frustrating it can be to spend time dealing with paperwork instead of patient care. "These rules will help healthcare professionals operate more efficiently, lowering their costs and reducing hassle for consumers."
The interim rule, which takes effect Jan. 1, 2013, is designed to make it easier for providers to determine whether a patient is eligible for coverage, and the status of a provider's claim for reimbursement to a health insurer because it will standardize the type of information and transmission formats for all providers and insurers.
According to a statement issued by HHS, the $12 billion in savings will come from reduced red tape because physicians, other health providers and health insurance companies will need to make fewer phone calls, spend less in postage, and will waste less time fighting denied claims. The administrative burdens involved in providing healthcare will become much more automatic.
The Medical Group Management Association's William F. Jessee, MD, issued a statement late Thursday saying he's pleased by the administration's operating rules. "MGMA championed administrative simplification as one of our primary advocacy initiatives during consideration of the Affordable Care Act."
Jessee said the rules will have a significant positive impact and "will improve the efficiency of these transactions by supplying timely and more robust eligibility information and streamlining medical groups' claims administration processes."
The "Red Tape" rule is said to be the first of several steps to streamline the system. Future rules will address adoption of
- Standards and operating rules for electronic funds transfer and remittance advice
- A standard unique identifier for health plans
- A standard for claims attachments
- Requirements that health plans certify compliance with all standards and operating rules set by the Health Insurance Portability and Accountability Act.
The administration is accepting comments on the rule through Sept. 6.