The Department of Health and Human Services (HHS) has released for comment the first in a series of proposed new operating rules aimed at standardizing and improving electronic healthcare transactions. The rules will reportedly cut red tape in the healthcare system and eliminate inefficiencies in manual processes, saving an estimated $12 billion over the next 10 years.

Under the first proposal, insurers would be required to provide uniform claims and coverage information using uniform formats. Healthcare providers would then be required to use a standard information request to obtain patient-specific information. HHS hopes this process will simplify administrative functions, facilitate the identification as to whether or not patients are eligible for coverage, and learn the status of previously submitted claims. Health plans, healthcare clearinghouses, and certain healthcare providers would be required to be compliant by January 1, 2003 under implementation of part of Section 1104 of the Affordable Care Act.

The rule was sparked, in part, by a May 2010 study in Health Affairs that suggested physicians spend almost 12% of every dollar received from patients to cover costs of excessive administrative complexity. The study authors argued that simplifying these complexities could save 4 hours of professional time per physician and 5 hours of support staff time per week. “Doctors and health insurance companies waste thousands of hours and billions of dollars filling out forms and processing paperwork,” said HHS Secretary Kathleen Sebelius. “The Affordable Care Act is helping doctors operate more efficiently and spend their time treating patients, not filling out papers.”

Comments on the new rule will be accepted until 5:00 pm EST on September 6, 2011.

HHS Affordable Care Act News Release

Download the proposed HHS Rules

Physician’s Weekly
wants to know…

  • Do you think the answers to insufficiencies in healthcare lie in the adoption of health information technology?
  • Do you believe claims standards and requirements can help save significant dollars in reduced transaction costs?
  • Have you already found ways in your practice or hospital to eliminate costs associated with healthcare transactions?