HHS seeks to simplify electronic transactions for doctors

By Diana Manos
10:48 AM
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The Department of Health and Human Services has issued an interim final rule aimed at cutting red tape for providers transmitting information electronically.

The “Administrative Simplification: Adoption of Operating Rules for Eligibility for a Health Plan and Health Care Claim Status Transactions” is expected to save doctors, patients and insurers $12 billion, according to HHS officials. The rule is part of a plan to reduce administrative costs mandated under the Affordable Care Act.

According to HHS officials, savings will come from the improved use of electronic standards that will help eliminate inefficient manual processes.

A May 2010 study in Health Affairs found that physicians spend nearly 12 cents of every dollar they receive from patients to cover the costs of excessive administrative complexity. Simplifying those systems, the study indicated, could save four hours of professional time per physician and five hours of support staff time every week – time that could be better spent on patient care.

[See also: MGMA chief calls on medical groups to help remake healthcare .]

“Doctors and health insurance companies waste thousands of hours and billions of dollars filling out forms and processing paperwork,” said HHS Secretary Kathleen Sebelius. “The Affordable Care Act is helping doctors operate more efficiently and spend their time treating patients, not filing out papers.”

The interim final rule requires compliance by health plans, healthcare clearinghouses and certain healthcare providers by Jan. 1, 2013. It puts in place operating rules for two electronic healthcare transactions, making it easier for providers to determine whether a patient is eligible for coverage and the status of a healthcare claim submitted to a health insurer.

According to HHS officials, the new operating rules will provide greater uniformity of information and transmission formats so that physicians and other healthcare providers can use one type of information request for all insurers, rather than being required to use multiple systems. 

HHS officials said the rule largely adopts operating rules developed by the Council for Affordable and Quality Healthcare’s Committee on Operating Rules for Information Exchange (CAQH CORE), a health industry coalition that focuses on ways to simplify healthcare administration for plans and providers. 

[See also: CORE helps streamline electronic healthcare payments at point of care.]

CAQH CORE offered a set of potential operating rules that are currently in use in the healthcare industry on a voluntary basis, and which have demonstrated a significant return on investment.

The interim final rule can be found online here. The rule is scheduled for publication on July 8, 2011. Comments will be accepted if submitted through Sept. 6, 2011.

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