First-ever paperwork-standardization requirements for health insurers aim to save the healthcare industry $12 billion over the coming decade by allowing greater automation.
An interim final rule issued today by HHS
specifies the information that insurers must give to healthcare providers when contacted. The specific data requirements apply to provider inquiries about patient coverage eligibility and the status of submitted health claims.
“It's about simplifying the business side of healthcare so physicians can spend more time on the clinical side of healthcare,” CMS Administrator Dr. Donald Berwick said in a conference call about the new rule.
Despite its overall savings, the rule will carry near-term costs for healthcare entities, including up to $5 billion for insurers and $800 million for providers over the first 10 years, according to an HHS spokesman.
The requirements are the first in what is expected to be a series of required operational changes for the healthcare industry authorized by the Patient Protection and Affordable Care Act.
They are similar to operating rules developed by the Council for Affordable and Quality Healthcare's Committee on Operating Rules for Information Exchange, a health industry coalition.
The new requirements are effective Jan. 1, 2013.