The American Hospital Association has widely backed recommendations from the Committee on Operating Rules for Information Exchange for streamlining claims- processing procedures for electronic transactions.
This week, it submitted comments on the Center for Medicare & Medicaid Services' (CMS) interim final rule concerning the Adoption of Operating Rules for Health Care Electronic Funds Transfers and Electronic Remittance Advice Transactions contained in the Patient Protection and Affordable Care Act.
In urging CMS to quickly adopt CORE's operating rules, the AHA called them "an important step forward to advance administrative simplification and burden reduction." The rules were published Aug. 7, with a comment period ongoing through Tuesday. They are set to go into effect Jan. 1, 2014.
The new rules to eliminate administrative obstacles to electronic claim payments and adjustments to those payments are expected to save doctors, hospitals and insurers up to $9 billion over the next 10 years.
"The AHA agrees with CMS's recognition of the interdependence of the EFT and the ERA and their importance in reducing the cumbersome routines required of providers," Linda Fishman, AHA senior vice president of policy analysis and development, wrote. "These operating rules will help hospitals achieve savings by establishing consistent data collection routines, and establishing EFT instructions; thus, they will enable health plans to quickly establish EFT relationships with providers and their banks. Most importantly, the operating rules will alleviate the "reassociation" problem of matching the EFT to the related ERA, especially when these distinct transactions are submitted on different dates and take different paths in getting to the provider."
Fishman also urged CMS take the lead in providing instructional materials to clarify the correct use of reassociation data on both the EFT and ERA.
She also said AHA:
- Supports the establishment of consistent definitions through the use of the CORE operating rules when health plans use claim adjustment reason codes (CARC) as well as remittance advice remark codes (RARC).
- Agrees that development of operating rules should be open and engage relevant stakeholders.
- Believes that major new rules or substantial revisions should go through the public notice and comment process, currently required; however, technical corrections, clarifying changes or updates should be fast-tracked.
- Urges the U.S. Department of Health & Human Services to address the protected health information issue as it pertains to commonplace financial instruments as well as emerging applications found in mobile devices.
Three weeks ago, the Healthcare Information and Management Systems Society issued its own recommendations to help financial institutions comply with federal privacy laws for protected patient health data.
"As customers of financial institutions, healthcare providers and payers need assurances that financial institutions can safeguard protected health information with appropriate technology systems, infrastructure, and procedures for risk management and incident management," it said.
To learn more:
- read the comments (.pdf)