WEDI: HIPAA compliance, payment recoupment concerns inhibit electronic payment adoption

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Technical and administrative challenges have limited EFT adoption among providers and payers.

HIPAA noncompliance among payers and concerns about overpayment recovery among providers are among the issues identified by a national health IT workgroup that has limited the adoption of electronic payments designed to streamline administrative tasks.

Greater collaboration between payers, providers and vendors to sort through those technical and administrative barriers would ensure more payment interactions are conducted electronically, according to a report released by the Workgroup for Electronic Data Interchange (WEDI), a health IT adviser for the Department of Health and Human Services.

The group says some payers are not fully HIPAA compliant because they don’t offer both electronic funds transfer (EFT), which submits payments electronically, and electronic remittance advice (ERA), which provides claims explanations in a HIPAA-compliant format. Adopting one transfer method without the other creates an administrative burden and reduces the benefits of processing payments electronically.

Technical upgrades could resolve those issues, WEDI noted.

Meanwhile, providers are sometimes concerned payers will use EFT capabilities to recoup overpayment by debiting an account without their knowledge, the report states. Clearer communication about the payment recoupment process and safeguards to protect against unauthorized debits can resolve some of those concerns and improve EFT adoption.

RELATED: 1 out of 6 physician practices ‘fleeced’ with fees for receiving electronic payments

The report comes a week after a survey by the Medical Group Management Association (MGMA) found 17% of physician practices reported their EFT payments came with a fee.

“Even though health plans save money not printing and mailing paper checks, some bad actors are fleecing physician groups by charging them to simply receive an electronic paycheck,” said Anders Gilberg, MGMA’s senior vice president for government affairs.

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