CMS Rule Seeks to Streamline EFT and Remittance

The Centers for Medicare & Medicaid Services (CMS) released, Aug. 7, an interim final rule with comment period that specifies additional guidelines for health care electronic funds transfers (EFT) and electronic remittance advice (ERA) transactions. The goal is to allow health information “to be exchanged more efficiently, and to achieve greater uniformity in the transmission of health information. … by applying necessary business rules and guidelines for the electronic exchange of information,” according to CMS.

The interim final rule with comment period adopts the Phase III Council for Affordable Quality Healthcare (CAQH) Committee on Operating Rules for Information Exchange (CORE) EFT & ERA Operating Rule Set, including the CORE v5010 Master Companion Guide Template, for the health care EFT and remittance advice transactions, with one exception: Requirement 4.2 of the Phase III CORE 350 Health Care Claim Payment/Advice (835) Infrastructure Rule will not be adopted.

Among other requirements, the Operating Rule Set obligates health plans to send an EFT within a certain number of days of the electronic remittance advice, making it easier for physician practices and hospitals to reconcile their accounts. The EFT & ERA Operating Rule Set also includes requirements for the initial setup for the electronic communication between providers and health plans.

According to CMS, the adoption and use of EFT by the health care industry has been low, resulting in unrealized administrative savings. This most recent final rule is the third in the series that, when implemented by health plans, is estimated will save from $300 million to $3.3 billion over the next 10 years.

CMS will accept comments on the final rule within 60 days of Aug. 6, 2012. All Health Insurance Portability and Accountability Act (HIPAA)-covered entities must be in compliance with the EFT & ERA Operating Rule Set by Jan. 1, 2014.

Source: CMS press release

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