The Secretary of the Department of Health and Human Services (HHS) has a new proposed rule that will call for the use of criteria for healthcare transactions and electronic signatures utilized together with those transactions to support healthcare cases and previous authorization dealings. The new guideline will impose the conditions of the Administrative Simplification Requirements of HIPAA and the Affordable Care Act and will implement it on all health plans, healthcare providers, and healthcare clearinghouses that are presently lacking an effective, consistent way of sending attachments.
At present, whenever making coverage decisions regarding healthcare services, health plans usually demand extra data that can’t be put in the particular fields or data elements of the implemented earlier authorization request or healthcare claims transaction. Presently, this data is routed via mail or via fax and is covered by manual procedures that require substantial time and resources. Currently, there are no followed HIPAA standards, implementation instructions, or operating guidelines that cover healthcare attachments or electronic signatures. The recommended rule will serve electronic transmissions of this sort of data.
According to the HHS, the healthcare sector has long expected the use of a number of HIPAA standards intended for the electronic exchange of clinical and administrative information to support electronic healthcare transactions, for example, earlier authorization of services and claims adjudication, and the proposed requirements can help reduce provider pressure.
The Administrative Simplification Rules of HIPAA required standard-setting organizations (SSOs) to create sets of standard codes for electronic healthcare transactions. Some of the codes were used earlier in the Transactions and Code Sets final rule. In 2005, there was a similar proposed rule to the HIPAA Administrative Simplification — the Standards for Electronic Health Care Claims Attachments Proposed Rule – – which recommended the use of criteria for health care claims attachment standards for particular service areas, such as ambulance services, emergency departments, clinical reports, lab results, prescription drugs, and rehabilitation services; nevertheless, according to the feedback obtained, the HHS opted not to complete that guideline.
The American Hospital Association (AHA) has launched its support for the recommended guideline and the use of a new HIPAA standard for attachments and electronic signatures because this will alleviate the burden on companies. Currently, without a HIPAA rule for attachment transactions, the processing of claims is delayed, which results in late payments and provision of patient care, and leads to provider burnout. The AHA advocates creating criteria for attachments to minimize the administrative difficulties faced by physicians and count on giving robust comments after examining the rule’s details.
The proposed rule will be released in the Federal Register on December 21, 2022. Feedback on the proposed rule ought to be sent by March 21, 2022.
