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New Standards

Electronic Funds Transfer (EFT)

On January 10, 2012, HHS published an Interim Final Rule with Comments (IFC) naming a standard for conducting an EFT transaction. The IFC was finalized on July 10, 2012. As with other HIPAA standards, physicians are not required to implement the electronic standard, but if they do, they must use the standard and a health plan covered under HIPAA must accept the transaction. All health plans covered under HIPAA must now comply with the new standard, as of January 1, 2014. Some payers, such as Medicare, require physicians, as a matter of doing business with them, to be paid via EFT even if they are not conducting HIPAA transactions - like claims – electronically.

EFT toolkit for physician practices

Resources
CMS fact sheet

CMS FAQs

Interim Final Rule with Comments

Claims Attachment

The AMA has long advocated for an attachment standard to be named under the Health Insurance Portability and Accountability Act (HIPAA) to streamline the process physicians use to send payers additional information requested to pay a claim. A complete solution for handling attachments is also expected to significantly reduce costs for physicians by automating the prior authorization process. ACA also requires the adoption of the Health Care Claims Attachment standard, which was a standard named in the 1996 HIPAA law, but not included in the 2000 Transactions and Code Sets Final Rule. In 2005, CMS published a Notice of Proposed Rulemaking to adopt the standard, but a Final Rule was never published. The effective date of the new standard will be January 1, 2016.

Resources
February 2013 AMA / MGMA Testimony to NCVHS on Attachment Transaction and Operating Rules

AMA Testimony to NCVHS on Claims Attachment Transaction

January 2006 AMA response to CMS on proposed Claims Attachment rule

AMA Advocates for HIPAA Standard for Attachments
In joint testimony to HHS’ National Committee on Vital and Health Statistics (NCVHS), the AMA and the Medical Group Management Association (MGMA) recommended HHS adopt the transaction standard for claims attachments (known as the X12 275). The AMA and MGMA also called for HHS to improve use of the existing named HIPAA standard which lets payers communicate with providers about the status of their claim (known as the X12 277), by allowing it to also be used by payers to request additional information needed from a provider. Together, the robust use of these two transactions could remove the largely manual, time consuming and expensive process for physicians when responding to payers’ varying attachment requests. In addition, the joint testimony urged NCVHS to find a way to ensure that innovative solutions to handling claims attachments could be allowed, should physicians elect to use them. Read the testimony.

Other Standard Transactions

There are other standard transactions that have been developed by the health care industry and are available for use, but are not mandated by HIPAA. While these transactions are not mandated, they can be implemented on a voluntary basis and used by willing trading partners. If you are interested in conducting any of these transactions using the standard, talk to your vendor and payers.

One set of these transactions are the Acknowledgements, which provides the ability to receive a message that your claims or other transactions were accepted and if not, why they were rejected. Using the standard cuts down on the manual work of following up on your claims and other transactions.

Resources
Questions to ask a health insurer before enrolling in an electronic transactions program

Questions to ask a billing service before enrolling in an electronic transactions program

Questions to ask a clearinghouse before enrolling in an electronic transactions program

Acknowledgements toolkit for physician practices

AMA Testimony to NCVHS on Acknowledgements