HHS advisory group says don’t switch to costly, untested claims tech

Kevin B. O'Reilly , Senior News Editor

What’s the news: A federal advisory body has issued recommendations that are completely aligned with the AMA’s comments and represent a major advocacy win to reduce administrative burdens and costs for physician practices.

The National Committee on Vital and Health Statistics (NCVHS) is an advisory body to the secretary of the Department of Health and Human Services (HHS).

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NCVHS recommended:  

  • Against adoption of new versions of the X12 electronic claim and remittance advice transactions, citing arguments made by the AMA and other stakeholders on the lack of information on the expected costs and ultimate value of this transition. 
  • That HHS address concerns raised by the AMA and others regarding virtual credit card payments and inclusion of the unique device identifier on electronic claims. 
  • Adoption of operating rules that will improve the quality and quantity of data in electronic eligibility responses, increase security of electronic transactions and better support physicians’ successful participation in value-based contracts. 

Learn more about the NCVHS recommendations regarding adoption of updated electronic transaction standards (PDF) and new and updated operating rules (PDF).

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Operating rules are “secret weapon” to fight burdens and burnout

Why it’s important: As detailed in a joint letter from the AMA and American Hospital Association (PDF), these operating rules offer considerable benefit to professionals and address unmet business needs and emerging market trends. The AMA’s successful advocacy with NCVHS will result in reduced administrative burdens, while also protecting practices from mandates to adopt costly, unproven new technology.

The NCVHS recommendations are totally in line with the AMA’s written comments (PDF) and hearing testimonies, representing a major advocacy win in reducing administrative burdens and costs for physician practices.  

“Many physicians—particularly those working in small or rural practices or serving minoritized or marginalized communities—face challenges in updating their health information technology systems due to limited resources,” AMA Executive Vice President and CEO James L. Madara, MD, wrote last year to NCVHS Chair Jackie Monson.

Dr. Madara added that the overall aim of the AMA’s advocacy in this arena is determine “how the health care industry can best leverage new technology to address unmet business needs without jeopardizing smoothly operating workflows or diverting limited health IT resources away from higher priority needs,” such as the automation of prior authorization and clinical documentation exchange.

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Why the end could be near for prior-authorization faxes

The most recent report published by the Council for Affordable Quality Healthcare tracking the health care industry’s annual progress toward automating basic transactions shows these types of transactions bringing up the rear. While 97% of claims are sent electronically, as are 90% of eligibility and benefit verifications, only 28% of prior authorizations are processed electronically. Similarly, only 24% of attachments are submitted electronically, and human interactions involving phone calls, faxes, email or standard mail are still heavily relied on in their transmission.

Learn more: Reducing physician burnout and fixing prior authorization are critical components of the AMA Recovery Plan for America’s Physicians.

Far too many physicians experience burnout. That's why the AMA develops resources that prioritize well-being and highlight workflow changes so physicians can focus on what matters—patient care.

Prior authorization is overused, and existing processes present significant administrative and clinical concerns. Find out how the AMA is tackling prior authorization with research, practice resources and reform resources.