More information from CMS on health plans charging fees for electronic payments

The Centers for Medicare & Medicaid Services (CMS) has published a set of FAQs clarifying the agency’s recent guidance on health plans and their vendors charging fees for electronic payments.

Among the takeaways:

• HIPAA does not prohibit health plans from charging fees for electronic funds transfers (EFT) and electronic remittance advices (ERA) transactions.
• However, if a physician or other provider requests electronic payment directly to a bank account through the Automated Clearing House Network instead of a virtual credit card (which usually carries fees), health plans must comply with that request.
• HIPAA does not require health plans to comply with a provider’s request for payment via paper check.
• A provider does not have to be affiliated with a health plan, or part of a health plan’s network, to receive EFT and ERA transactions using the adopted HIPAA standards.

CMS released its original guidelines in March in response to concerns raised by the American Academy of Family Physicians and other groups.

— Kent Moore, AAFP Senior Strategist for Physician Payment

Posted on Oct. 6, 2022