Physicians and their staffs may have a little less insurance paperwork to do, thanks to a coming Medicare regulation.
Scheduled to be published in the Federal Register, the interim final rule puts into place two rules on electronic health care transactions: one to make it easier to determine patients' health care coverage and the other to ascertain the status of a submitted claim.
Currently, when a physician's office staff seeks information on patient health care coverage, they may have to make the request in a different format for each health plan, but under the operating rules set out by Medicare the format will be standardized across all health plans. The changes, which were mandated under the Affordable Care Act, will go into effect on Jan. 1, 2013.
The new Centers for Medicare and Medicaid Services requirements are based largely on operating rules developed by the Council for Affordable and Quality Healthcare's Committee on Operating Rules for Information Exchange (CAQH CORE), an industry coalition that works on administrative simplification issues. The CAQH CORE rules are currently in use on a voluntary basis, CMS officials said.
The CMS estimates that the adoption of these two operating rules will result in about $12 billion in savings to physicians and health plans over the next decade, largely because of fewer phone calls between physicians and health plans, reduced paperwork and postage costs, increased opportunities to automate the claims process, and fewer denials.
In the future, the CMS plans to issue additional rules mandating the adoption of standards for electronic funds transfer and remittance advice, a standard unique identifier for health plans, a standard for claims attachments, and requirements that health plans certify compliance with the standards and HIPAA operating rules.
The interim final rule was released by CMS on June 30; the deadline to submit comments on the rule is Sept. 6.