Now that health plans are required to be compliant with the newly adopted operating rules for electronic funds transfers and electronic remittance advice, electronic transactions might be poised to overtake healthcare.
The rules were mandated by the Affordable Care Act and created by the Council for Affordable Quality Healthcare Committee on Operating Rules for Information Exchange Committee on Operating Rules for Information Exchange (CAQH CORE).
[See also: New rules on the horizon for electronic transactions]
New York’s Montefiore Medical Center was the first provider nationally to become CORE certified.
“We recognized early on the potential of administrative simplification, and the CORE rules and ACA mandates are the product of health plans, provider and vendors collaborating on the administrative issues contributing to costs within our healthcare system,” said Noam Nahary, director e-commerce and revenue cycle at Montefiore.
Nahary said the operating rules are a foundational component toward Montefiore’s goal of a “no touch” revenue cycle, meaning the rules allow for automating manual processes.
“Our focus, operationally and technically, on administrative simplification has yielded reductions in bad debt and increased revenue through automated verification of benefits on the front end and automated follow-up activities for pre-adjudication rejections and denials on the back end,” said Nahary.
According to the Electronic Payments Association, NACHA, more than 8 million healthcare EFTs via automated clearinghouse were made in January 2014, the first month in which health plans were required to be compliant with the newly adopted healthcare EFT standard transaction. These transactions moved approximately $45 billion from health plans to providers.
Sandra Wolfskill, healthcare finance policy director for revenue cycle at the Healthcare Financial Management Association, said the CORE’s operating rules bring a level of standardization to the table that encourages the use of technology-based operations.
“Operating rules and electronic rules result in generally faster and more accurate processing, greater ability to automate work flow and reduced manual intervention in processing high volume transactions as typically found in revenue cycle operations,” she said.
“I think it’s about setting expectations across the whole payment process,” said Gwendolyn Lohse, deputy director, CAQH, during an operating rules presentation at HIMSS14 in February. (HIMSS is the parent company of Healthcare Finance News.) “That we are going to be sharing a certain amount of data and that data is going to flow well and quickly with a certain level of security. So you're building up trust in the concept of data exchange, of financial information for the revenue cycle.”