The U.S. Department of Health and Human Services rolled out its first set of operating rules last year designed to help the healthcare industry increase the use of electronic means for passing payments and remittance advice and in early August rolled out another set of interim rules that should build on that foundation.
Robert Tennant, senior policy advisor at the Medical Group Management Association noted that under current methods, it can often be very hard for providers to match payments with claims, a vital step that is key to improving administrative efficiency.
“You get sent a paper check. Three weeks later you get the remittance advice. You’ve got to match them up, figure out if you got paid the right amount, do the reconciliation and go to the bank,” Tennant noted. “A lot of those things you’ll be able to automate. Every time you automate, you improve the efficiency.”
But there were many in the industry who felt the first set of rules, finalized just a couple of weeks before the newest set were proposed, didn’t do enough to clear the waters. But the newest interim rules have won over some who were critics.
Bill Marvin, president and CEO of healthcare payment network InstaMed was pleased the interim rules included changes to the information that is required to be sent along with the payments. “I’m very pleased with the new rules,” Marvin said. “Prior to this there was still some ambiguity and options that were laid out. Where we are now is we have a clear focus and clear guidance and it is what is needed to have focus.”
In particular, Marvin pointed to the rule that now would require trace numbers be included in electronic transmissions, as they would help solve the very problem Tennant noted about the difficulty of reconciling payments with remittance advice. InstaMed has been doing this for some time, he noted, and it has proven itself to be valuable to both payers and providers alike.
“We are happy that the rest of the market will have this as standard and adopt it,” Marvin continued. “Furthermore, let’s remember why we did this in the first place: we are reducing costs for healthcare providers and healthcare payers. If we are going to reduce the costs, we need to have the focus. And this delivers that focus.
With the interim rules now open for comment, Marvin and others have now turned their attention to other issues that may affect or slow adoption of the greater use of EFT and ERA in the industry, notably security issues.
But writing industry-specific rules may not be necessary, Marvin said. “This an area where HHS doesn’t need to re-write anything, they just need to reference other regulations that are in place that deal with payments and banks accounts.”
This article was originally published by HIMSS.