WEDI guide offers insight on Medicare claims payment rules

The clinical and financial impact of next year's slated conversion to the ICD-10 revision of diagnostic and procedural codes has been getting most of the publicity recently. But two other sets of federal rules impacting Medicare claims payment also will hit the healthcare industry in 2014.

The Patient Protection and Affordable Care Act required development of operating rules for both EFT and ERA and mandated the use of electronic funds transfer by Medicare. The compliance date for both rules is Jan. 1, 2014.

The Workgroup for Electronic Data Interchange has released a free 29-page guide on other rules. It covers the enrollment process for electronic funds transfers (EFT) and electronic remittance advices (ERA) to help hospitals, office-based providers, claims clearinghouses and health plans prepare for the rules mandated by the Affordable Care Act for Medicare. A final rule on EFT was published last July, while an interim final rule on the operating rules for EFT and ERA enrollment and other related components followed last August. HHS declared the interim rule would be the final rule in an April 19, 2013 announcement.

The protocols covered by the rules will enable the healthcare industry to shift from paper-based to electronic financial transactions. The shift will reduce the need for paper checks and the manual processing between health plans and other payers and healthcare providers, and will speed payments.

The guide explains the new rules and has recommendations on best practices and answers to questions healthcare entities may have now and in the future, Pamela Grosze, a vice president at PNC Bank, said in a news release.

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