New Rules Coming Jan. 1 Can Help Physicians Streamline Payment

New federal standards governing how health insurers conduct electronic transactions with physicians should help reduce administrative hassles, cut paperwork burdens and free up time to spend with patients.

The rules, called for under the Affordable Care Act, require health insurers to standardize business practices for electronic funds transfers (EFT) and electronic remittance advice. Set to take effect Jan. 1, 2014, the rules will make it possible for medical practices to automate the time-consuming process of manually matching payments from insurers with claims that have been submitted.

If a practice wants to set up payments to be direct deposited into its bank account via EFT-Automated Clearing House (ACH), and makes that request to the payer, the payer is required to make payments via that method to the practice.  The ACH transaction (the actual transfer of money by the payer to a practice’s bank) also requires the payer to include information that will allow you to re-associate/match the direct-deposit payments you receive to individual claims.

The Centers for Medicare & Medicaid Services estimates that approximately one-third of claim payments across the industry currently are transferred electronically, and insurers’ reliance on electronic funds transfers is expected to increase. Medicare rules already require physicians who are new to the program or who update their enrollment information to be paid via electronic funds transfer.

Free toolkits from the AMA can help physicians take advantage of the changes. The toolkits on electronic funds transfers and electronic remittance advice include informative sections on getting started with electronic transactions, key questions to ask vendors, guidance about information technology solutions, and an outline of the rules and standards for electronic transactions.

Visit the AMA website for updated information and resources that can help generate savings using electronic transactions.


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1 Comment

  • Allan Zacher, MD

    Well, I hope to heck that this streamlines Medicaid billing! I have not been paid for a SINGLE Medicaid (NC) patient since the July switch to NC TRACKS! We already have reduced reimbursement for these patients – but I HATE that we won’t be able to see them at all if we don’t get paid! My staff has been working diligently both through the web site and their lame and inconsistent telephone support and we’re not getting ANYWHERE!