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All Things HIT

Jan 9 2012   4:18PM GMT

New EFT payor requirements, better late than never!

Posted by: AllinHIT
EFT payor requirements, EHR billing, eRx, HHS rinal rule on electronic fund transfers

As a previous small business owner, I know the importance of cash flow to operations.  Having thousands of dollars in arrears because of client’s processing manual payments, has always negatively impacted cash flow.  Matter of fact, increasing cash flow was the impetus for me selling the” cash cow” of that business.   However, this was in the late 90’s! Now, in this first month of 2012, HHS has published its interim final rule on electronic fund transfers requirements, and from my standpoint, it is decades late!  However, I will reference the adage that “it’s better late, than never”.

In the late 80’s, I worked for NDCHealth (acquired by McKesson) as a marketing specialist.  My role was to market the NDC DataStat pharmacy system to independent pharmacies.  Part of the system was an online, real-time adjudication module for prescriptions.  I remember a particular pharmacist/owner asking, “since this transmission is two – way and the payor knows this script is being filled, is there a way I can receive the payment electronically?” At that time, EFT was not implemented in the module, so I remember discussing about the other benefits of implementing real-time adjudication for these claims.  I mentioned lowering rejection rates, easier pay reconciliation by payor and cutting remittance times.   His next question was, “why not?”.

Today, because of these new requirements, physicians will no longer have to ask that question. I found it interesting that only 15% of remittances are being electronically transmitted, a small percentage considering 99% of physician offices have EDI capabilities, either through their PMS or biller.  Physicians will now be able to increase their cash flow for operations (maybe they can buy that EHR!), reconcile easier by matching the remittance to the appropriate payor, eliminate some  paper and increase the overall efficiency of the practice.  I applaud HHS for this final rule, despite its late arrival!

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