New federal rules for electronic claims payments will cut red tape and could save healthcare providers and plans as much as $9 billion over the next decade, the Department of Health and Human Services says.
The interim final rules, announced this week, use the healthcare electronic fund transfer standards that the federal government adopted in January. The EFT and electronic remittance advice operating rules, also announced this week, are projected to save between $2.7 billion and more than $9 billion in administrative costs over 10 years by cutting manual administrative processes for providers and plans, HHS said in a media release.
"These new rules will cut red tape, save money, and ensure doctors spend more time seeing patients and less time filling out forms," HHS Secretary Kathleen Sebelius said.
Under existing manual payment systems, physicians and hospitals deposit paper checks and post and reconcile claims payments in their accounting systems. HHS says receiving payments electronically and automating the posting of the payments will reduce administrative time and expenses for physicians and hospitals.
Studies have shown that the average physician spends three weeks a year haggling with payers over bills. It has been estimated that in a physician’s office two-thirds of a full-time employee is needed for each physician is to conduct these administrative tasks.
The new operating rules include best business guidelines for electronic transmissions and tackle sticking points that physician practices and insurers have with electronic transactions. For example, the rule announced this week requires insurers to offer a standardized online enrollment for EFT and ERA so that physicians and hospitals can easily enroll with several health plans to receive electronic transactions.
The rule also requires health plans to send the EFT within a set amount of days of the ERA. That helps providers reconcile their accounts more quickly, HHS said in the media release.
Susan Turney, MD, president/CEO of the Medical Group Management Association-American College of Medical Practice Executives, says her organization "strongly supports" the regulations adopting EFT and ERA.
"Receiving and processing paper checks is cumbersome and inefficient. These standardized operating rules will increase efficiency and allow practices to allocate resources to patient care instead of wasteful administrative tasks," Turney said in prepared remarks.
The regulation takes effective upon its publication in the Federal Register on Friday. The comment period closes Oct. 9. The compliance date for operating rules for the healthcare electronic funds transfers and remittance advice transaction is Jan. 1, 2014, HHS said.
John Commins is the news editor for HealthLeaders.