Streamlined claims rule would save your practice time and money

August 10, 2011

The interim final rule was released in early July by the Department of Health and Human Services (HHS) and is available for comment until September 6. It requires insurers to use uniform transmission formats and standardized forms when they request information or provide patients' claims and coverage information to doctors.

A proposed rule may offer some relief if you, like most physicians, would rather be seeing patients than trapped on the telephone for interminable hours, providing additional information to insurers and arguing about claim denials.

The interim final rule was released in early July by the Department of Health and Human Services (HHS) and is available for comment until September 6. It requires insurers to use uniform transmission formats and standardized forms when they request information or provide patients' claims and coverage information to doctors.

Citing a study that appeared in the journal Health Affairs in 2010, HHS says the new rules would save an estimated $12 billion in the healthcare system by reducing telephone calls between physicians and health plans, lowering postage and paperwork costs, creating fewer claim denials for physicians, and automating healthcare administrative processes.

The proposal tracks closely the recommendation of the Council for Affordable and Quality Healthcare's Committee on Operating Rules for Information Exchange, and is the first of several to be created in response to the simplification provisions contained in the Patient Protection and Affordable Care Act.

A benefit of the new rule could be fewer errors. A recent American Medical Association report found that health plans make errors in nearly one out of five claims, and that 3.6 million more commercial claims had processing errors than last year.

If approved, the new rule would take effect at the beginning of 2013.

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