1) Dec 21 -- Administrative Simplification: Adoption of Standards for Health Care Attachments Transactions and Electronic Signatures, and Modification to Referral Certification and Authorization Transaction Standard
This rule would implement requirements of the Administrative Simplification subtitle of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010, enacted on March 30, 2010—collectively, the Affordable Care Act. Specifically, this proposed rule would adopt standards for “health care attachments” transactions, which would support both health care claims and prior authorization transactions, and a standard for electronic signatures to be used in conjunction with health care attachments transactions. To better support the use of the proposed standards for attachments transactions with prior authorization transactions, this rule also proposes to adopt a modification to the standard for the referral certification and authorization transaction (X12 278) to move from Version 5010 to Version 6020.
To be assured consideration, comments must be received at one of the addresses provided below, no later than 5 p.m. on March 21, 2023.
This rule proposes to adopt a set of standards for the electronic exchange of clinical and administrative data to support prior authorizations and health care claims adjudication. In determining the necessity of a health care service as part of making a coverage decision, health plans often require additional information that cannot adequately be conveyed in the specified fields or data elements of the adopted prior authorization request or health care claims transaction. If adopted as proposed, this proposed rule would support electronic transmissions of this type of information, which should have the effect of decreasing the use of time and resource-consuming manual processes such as mail or fax often used today to transmit this information. This would facilitate prior authorization decisions and claims processing, reduce burden on providers and plans, and result in more timely delivery of patient health care services.
This rule would adopt a set of standards for the electronic exchange of clinical and administrative data to support prior authorizations and claims adjudication. Despite widespread deployment of electronic health records (EHRs), and industry experience with Health Insurance Portability and Accountability Act of 1996 (HIPAA) standards that continues to advance since HIPAA's advent, transmitting health care attachments is still primarily a manual process and, at this time, there are no adopted HIPAA standards, implementation guides, or operating rules for health care attachments or electronic signatures. If adopted, this proposed rule would support electronic transmissions of this type of information rather than the use of manual processes such as mail and fax that still predominate in the health care industry.
We believe that the health care industry has long anticipated the adoption of a set of HIPAA standards for the electronic exchange of clinical and administrative data to support electronic health care transactions, such as prior authorization of services and claims adjudication, and the standards we are proposing to adopt are an important step in reducing provider burden.
This rule would implement requirements of the Administrative Simplification subtitle of HIPAA and the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010, enacted on March 30, 2010—collectively, the Affordable Care Act. Specifically, this proposed rule would adopt standards for “health care attachments” transactions, which would support health care claims and prior authorization transactions, and a standard for electronic signatures to be used in conjunction with health care attachments transactions. This rule also proposes modifying the referral certification and authorization transaction standard to move from the X12 278, Version 5010, to the X12 278, Version 6020.
Based on industry research by the Council for Affordable Quality Healthcare (CAQH), the 2019 CAQH report indicates that a fully electronic system for prior authorization with health care attachments could result in as much as $454 million in annual savings to the health care industry. Similar savings can be expected for the industry by switching to health care attachments for claims. The 2019 CAQH report further estimates that the industry could expect as much as $374 million in savings per year with the full adoption of health care attachments for claims. This results in total anticipated industry savings of $828 million per year for prior authorization and claims.
FRN:
https://www.federalregister.gov/d/2022-27437
2) Dec 19 -- HHS Proposes to Standardize Electronic Health Care Attachments Transactions and Electronic Signature Processes to Improve the Care Experience for Patients and Providers (press release)
The Centers for Medicare & Medicaid Services (CMS), on behalf of, the U.S. Department of Health and Human Services (HHS), issued the proposed rule, “Adoption of Standards for Health Care Attachments Transactions and Electronic Signatures, and Modification to Referral Certification and Authorization Transaction Standard (CMS-0053-P).” If finalized, the proposed rule, would adopt standards for “health care attachments” transactions, such as medical charts, x-rays, and provider notes that document physician referrals, and office or telemedicine visits. The modifications to the adopted Health Insurance Portability and Accountability Act of 1996 (HIPAA) transactions would support both health care claims and prior authorization transactions, standards for electronic signatures to be used in conjunction with health care attachments transactions, and a modification to the standard for the referral certification and authorization transaction. The proposed rule estimates a savings of $454 million annually in administrative costs and is a part of HHS’ and the Centers for Medicare & Medicaid Services’ (CMS) ongoing efforts to significantly reduce paperwork burdens and empower health care providers to focus on direct patient care and streamline the care experience for patients and providers.
“The proposals in this rule would provide a valuable tool to support the electronic submission of health care information,” said CMS Administrator Chiquita Brooks-LaSure. “Health care providers are often forced to use manual processes such as mail, fax, or internet web portals when they respond to requests from health plans, leading to delays and less time for patient care. These important steps would promote more consistent and reliable communications among the partners involved in health care transactions, improving the care experience for all.”
HIPAA and the Affordable Care Act require the HHS Secretary to adopt a health care claim attachment standard. HHS is proposing these new requirements on HIPAA-covered entities, which include health plans, health care clearinghouses, and health care providers who electronically transmit any health information in connection with transactions for which HHS has adopted standards.
The proposed rule considers extensive stakeholder feedback and aims to support health care claims and streamline prior authorization transactions. By doing so, this rule would help make the process of submitting and adjudicating health care claims more efficient by providing structured, standardized electronic data to payers. The improved standards for electronic signatures will be used in conjunction with health care attachments transactions. The rule also proposes to adopt a modification to the standard for the referral certification and authorization transaction, thereby reducing potential barriers to adopting value-based payments and significantly easing unnecessary administrative costs and burdens on providers and health plans.
The proposed rule is available to review here
https://www.federalregister.gov/public-inspection/2022-27437/administrative-simplification-adoption-of-standards-for-health-care-attachments-transactions-and, and the deadline to submit comments is March 22, 2023. [FRN says March 21.] CMS encourages comments from all interested members of the public, and in particular, from patients and their families, providers, clinicians, consumer advocates, health plans, and health care professional associations.
Fact sheet:
https://www.cms.gov/newsroom/fact-sheets/administrative-simplification-adoption-standards-health-care-attachments-transactions-and-electronic
Press release:
https://www.cms.gov/newsroom/press-releases/hhs-proposes-standardize-electronic-health-care-attachments-transactions-and-electronic-signature