Streamlining Administrative Tasks Focus of New Interim Final Rule From HHS

The average physician spends the equivalent of three weeks out of every year billing and working on insurance-related tasks. In many instances, physicians still perform these tasks manually, expending a great deal of time and energy on administrative duties that could be handled more effectively and efficiently through electronic records and transfers, according to HHS.

To help alleviate some of this burden, HHS recently issued an interim final rule that is designed to promote electronic information transfers as a way of reducing the administrative burdens of billing and other insurance-related tasks, thus saving time and money. "Many physician practices and hospitals receive and deposit paper checks and manually post and reconcile the health care claim payments in their accounting systems," says an HHS press release. "By receiving payments electronically and automating the posting of the payments, a physician practice's and hospital's administrative time and costs can be decreased."

The new rule, which was published in the Aug. 10 Federal Register, establishes operating rules for electronic remittance advice (ERA) standards, effectively building on electronic fund transfer (EFT) standards adopted by HHS in January. These and other administrative simplification-related regulations are projected to save between $2.7 billion and more than $9 billion during the next 10 years, says HHS.

Although physicians, hospitals and health plans will all reap the financial benefits of the rule, health plans, as senders of the information, will incur most of the costs of implementing the rule, according to a CMS fact sheet.

The interim rule describes effective ways to use electronic transactions and seeks to eliminate obstacles that physician practices and health plans encounter when using electronic transactions. It also requires insurers to provide a standardized, online enrollment for EFT and ERA to make it easier for physicians and hospitals to enroll with multiple health plans.

This is the third in a series of regulations on electronic transfers issued by HHS during the past year. The first regulation adopted operating rules for two electronic health care transactions to make to it easier for physician practices and hospitals to determine whether a patient is "eligible for coverage and the status of a health care claim submitted to a health insurer." according to CMS. That was followed by a second regulation adopting standards for health care payments made through ERA and EFT standards.

The comment period for the interim final rule closes on Oct. 9, and compliance is required by Jan. 1, according to HHS.