Electronic funds transfer rule streamlines bookkeeping

January 11, 2012

Government and commercial health plans must now use an electronic tracking number to match your claim and the plan’s payment, according to a federal rule that went into effect this year.

Government and commercial health plans now must use an electronic tracking number to match your claim and the plan’s payment, according to a federal rule that went into effect this year.

The interim rule, “The Adoption of Standards for Health Care Electronic Funds Transfers and Remittance Advice,” is expected to save $3 billion to $4.5 billion in administrative costs for doctors and hospitals, private health plans, states, and other government health plans over the next 10 years, according to estimates published by the U.S. Department of Health and Human Services (HHS).

The electronic transfer rule builds on a Patient Protection and Affordable Care Act regulation from 2011 requiring healthcare organizations to use electronic systems to determine a patient’s eligibility for coverage and to check on a claim’s status. Together, the rules are expected to save $16 billion.

Currently, after physicians file a claim, payers send practices remittance advice that may or may not accompany the payment the provider receives. The separation between the two makes it difficult-or sometimes impossible-for a practice to match up the bill and the corresponding payment.

The interim final rule requires payers to use a single electronic file format and a tracking number that automatically matches the two to help practices avoid manual reconciliation. Physician practices will have “little to no cost to implement the healthcare electronic funds transfer standards, as providers are the receivers of the standardized transaction and not the senders,” according to HHS.

A May 2010 study in the journal Health Affairs found that physicians spend nearly 12% of every dollar they receive from patients to cover the costs of filling out forms and performing other administrative tasks. The study found that simplifying these systems could save 4 hours per week of professional time per physician and 5 hours of support staff time every week.

The regulation became effective January 1. All health plans covered under the Health Insurance Portability and Accountabilty Act must comply by January 1, 2014.

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