Most health plans al­ready com­ply­ing with new EFT stan­dards, AHIP says

Health plans com­ply­ing with stan­dards, AHIP says

Modern Healthcare - - EDITORIAL MODERN HEALTHCARE - Mau­reen Mck­in­ney

Health plans have two years to com­ply with new stan­dards for elec­tronic funds trans­fers, is­sued by HHS on Jan. 5. But ac­cord­ing to a health in­sur­ance in­dus­try trade group, most plans are al­ready on board with the re­quire­ments, which in­clude uni­form for­mat and con­tent re­quire­ments for elec­tronic pay­ment.

“We are re­view­ing the reg­u­la­tion, but this is con­sis­tent with what health plans use to­day and some­thing we have been sup­port­ive of,” a spokesman for Amer­ica’s Health In­sur­ance Plans said in an e-mail.

Man­dated by the health­care re­form law, the in­terim fi­nal rule, sched­uled to be pub­lished in the Jan. 10 Fed­eral Reg­is­ter, stan­dard­izes elec­tronic funds trans­fers and re­mit­tance ad­vice, or no­tice of pay­ment. The reg­u­la­tion, which is open for com­ment un­til March 9, re­quires the use of a trace num­ber that will link the trans­fers with re­mit­tance ad­vice, thereby re­duc­ing in­ef­fi­ciency, HHS said.

“The dis­con­nect be­tween the two makes it dif­fi­cult or some­times im­pos­si­ble for the provider to match up the bill and the cor­re­spond­ing pay­ment,” HHS said in a news re­lease. Trace numbers will avoid “costly

man­ual rec­on­cil­i­a­tion that must cur­rently be done,” HHS said.

HHS says the move will save up to $4.5 bil­lion over the next 10 years. That fig­ure jumps to about $16 bil­lion when ear­lier elec­tronic stan­dards—is­sued in July for health cov­er­age el­i­gi­bil­ity and claim sta­tus—are fig­ured in, the depart­ment said in the re­lease.

Those sav­ings es­ti­mates are re­al­is­tic, said Rose­mary Sheehan, vice pres­i­dent of rev­enue-cy­cle op­er­a­tions for 12-hos­pi­tal Part­ners Health­care, Bos­ton. She ac­knowl­edged that many plans are al­ready pay­ing claims elec­tron­i­cally or have a plan to get there, but she said the rule was needed to push com­pli­ance among other pay­ers, in­clud­ing smaller ones, and to en­sure uni­form prac­tices.

The worry lies in how the rule will be en­forced, added Sheehan, who coau­thored a 2010 study in Health Af­fairs high­light­ing the cost of a com­pli­cated pay­ment struc­ture and call­ing for a more stream­lined billing sys­tem. “Who will make sure plans take these stan­dards and in­ter­pret them in the same way?” she said.

Sheehan ap­plauded the new stan­dards, but said the larger is­sue is health plans’ com­mu­ni­ca­tion about their billing rules. “Most pay­ers do not pub­lish their billing rules and they refuse to pro­vide that kind of de­tail when we re­quest it,” she said. “We’re told that in­for­ma­tion is pro­pri­etary and we’re left to fig­ure it out on the fly.”

Each payer has dif­fer­ent rules for billing for each ser­vice, Sheehan said, and that means a lot of sys­tem mod­i­fi­ca­tions and additional ad­min­is­tra­tive costs. “We could make it a lot eas­ier with one set of rules, but I think pay­ers would view it as a com­pet­i­tive dis­ad­van­tage,” she said. “I don’t see that on the hori­zon.”

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