Standards for streamlining physician payment coming Jan. 1

Beginning Jan. 1, 2014, family physicians and all other entities covered by HIPAA must comply with operating rules regarding electronic funds transfer (EFT) and electronic remittance advice (ERA).

These rules, called for under the Affordable Care Act, require health insurers to standardize business practices for EFT and ERA, and they will make it possible for medical practices to automate the time-consuming process of manually matching payments from insurers with claims that have been submitted. That, in turn, should help reduce administrative hassles and paperwork burdens and free up time to spend with patients.

The Centers for Medicare & Medicaid Services estimates that approximately one-third of claim payments across the industry currently are transferred electronically, and insurers’ reliance on EFT is expected to increase. Medicare rules already require physicians who are new to the program or who update their enrollment information to be paid via EFT.

The operating rules were established by the Council for Affordable Quality Healthcare's (CAQH) Committee on Operating Rules for Information Exchange (CORE). To ensure that physicians are prepared to meet their deadline obligations, CAQH and CORE already have begun to roll out a series of online resources. Physicians should check the CAQH website regularly to read updated fact sheets about the rules, access helpful tools, and sign up for educational sessions and webinars that will assist in compliance preparations.

Free toolkits from the American Medical Association (AMA) can also help physicians take advantage of the changes. The AMA toolkits on EFT and ERA include informative sections on getting started with electronic transactions, key questions to ask vendors, guidance about information technology solutions, and an outline of the rules and standards for electronic transactions.

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians