AMA Wire

Wednesday, Jan. 9, 2013

Practice News

New rules should cut through claims process red tape

Two sets of new operating rules that took effect Jan. 1 should help physicians streamline critical parts of the claims process.

Under the Affordable Care Act, health insurers are now required to provide specific information in their responses to physicians' electronic inquiries about patient eligibility and claim status.

For instance, the new operating rules dictate that insurers cannot respond to electronic eligibility inquiries with only a "yes" or "no." Rather, insurers must include specific details, such as patient copayments and deductibles, so physicians and patients have the financial information they need at the time of care.

Similarly, physicians now should receive more precise information about the status of their claims.

The Centers for Medicare & Medicaid Services (CMS) estimates that the new rules will save $12 billion by cutting down the number of denied claims, automating administrative processes, and reducing time spent on the phone or completing paperwork.

While CMS has announced that the rules will not be strictly enforced until March 31 to prevent undue disruption to claims processing, insurers are required to work toward full compliance during this time. Physicians can complete a simple online complaint form to report an insurer that is not following the new operating rules.

Additional operating rules covering such electronic health care transactions as electronic funds transfer and coordination of benefits will take effect over the next three years.

Visit the AMA's HIPAA Operating Rules Web page to learn more about the new operating rules and access resources to help physicians make the most of electronic health care transactions.

Considering a cash practice? What you should know

A resource from the AMA outlines cash practice options and explains what is involved in transitioning to a new model.

Along with descriptions of five different cash practice models, the resource offers guidance on how adopting one of these models can impact a physician's existing patients, colleagues and practice operations. The resource also outlines important steps for making a smooth transition.

Cash practice models hold the possibility of reduced administrative overhead, fewer frustrations with insurers and more time with patients. But physicians need to carefully evaluate such a decision and understand how to tackle a transition.

Read a recent column in American Medical News to learn more about fee and contracting considerations.

Additional resources to help physicians manage their cash practices are available from the AMA Practice Management Center.