AMA Advocates for Administrative Simplification
Administrative simplification in the physician practice
Inefficient health care claims processing, payment and reconciliation carry estimated costs of between $21 and $210 billion¹. In the physician practice, this expense equals, on average, 10-14 percent of practice revenue². The administrative simplification objective within the physician practice is to encourage:
- automated, real-time health plan transactions
- reduction of manual processes throughout the physician’s claims revenue cycle
- increased transparency and reduced ambiguity during the health insurer claim payment process
The AMA is committed to addressing and advocating for the following solutions to the ongoing problems in the claims revenue cycle—problems which contribute to increased complexity and expense.
1: PNC Bank (2007), Commonwealth Fund (2007); RAND Corporation (2005), PricewaterhouseCoopers, 2008
2: Kahn, J. G., “Billing and Insurance-Related Administrative Costs: Burden to Health Care Providers”, IOM Roundtable: The Healthcare Imperative, May 2009.
The National Committee on Vital and Health Statistics (NCVHS) is the federal agency responsible for electronic health care transaction standards and other administrative simplification provisions contained within the Patient Protection and Affordable Care Act (ACA). The AMA has provided extensive NCVHS testimony regarding administrative simplification to ensure physicians’ interests in fully automating their practices are represented. Elimination of the manual processes and administrative hassles endured today can only occur if NCVHS adopts standards which meet the needs of all stakeholders, rather than just the interests of health plans.
- Read the AMA's comments on the National Medical Device Postmarket Surveillance Planning Board’s report “Strengthening Patient Care: Building an Effective National Medical Device Surveillance System.”
- Federation of medicine sign-on letter regarding Prior Authorization and Appropriate Use Criteria
- Read the joint letter of the AMA, American Hospital Association, Medical Group Management Association, and NACHA on health plan usage of virtual card payments.
- Read the AMA letter in support of operating rules for electronic funds transfer (EFT) and electronic remittance advice (ERA) adopted by the Centers for Medicare and Medicaid Services (CMS).
The AMA encourages you and your organization to get involved with ASC X12, CAQH CORE, NCPDP and WEDI. These organizations are leading the development and use of electronic standard health care transactions and need your input.
Learn more about electronic health care transactions, and about how AMA is advocating for physicians within these organizations.