The Centers for Medicare and Medicaid Services (CMS) finalized a rule that aims to phase out fax machines and paper mailings for healthcare claims documentation.
The agency’s final rule, announced Friday, would establish national standards for the electronic exchange of clinical documentation used to support healthcare claims. The rule also adopts standards for electronic signatures to ensure secure, authenticated transmission of this information, CMS said.
The rule, called the Administrative Simplification; Adoption of Standards for Health Care Claims Attachments Transactions and Electronic Signatures final rule, is effective on May 26. HIPAA-covered entities, including health plans, healthcare clearinghouses and healthcare providers that conduct electronic transactions, must comply by May 26, 2028.
CMS estimates the rule will save the healthcare industry roughly $782 million a year.
“The 1980s called, and they want their fax machines back,” said CMS Administrator Dr. Mehmet Oz said in a statement. “The futuristic medical breakthroughs we’ve achieved, like augmented reality glasses that give surgeons X-ray vision, shouldn’t have to coexist with administrative systems that often lag decades behind. This new rule will modernize American healthcare by standardizing electronic claims attachments and enabling secure electronic signatures. Because every minute providers save on paperwork is another minute they can spend caring for patients.”
The proposed rule was issued in December 2022, during the Biden administration.
It’s estimated that 9 billion fax pages are exchanged each year in healthcare, according to data from 2020. Fax machines are still commonly used across the industry today with a large number of healthcare providers continuing to use fax machines to exchange medical information.
CMS argues that relying on outdated manual methods to submit additional claims-related documentation requested by health plans, including medical records, X-rays, clinical notes, telemedicine visit documentation and laboratory results, causes delays and unnecessary costs.
The final rules establishes the first HIPAA-adopted standards for healthcare claims attachments, enabling the secure electronic exchange of health care claims-related supporting clinical documentation such as medical records, X-rays and imaging, clinical notes, telemedicine visit documentation and laboratory results, the agency said in a fact sheet.
With the final rule, CMS aims to establish a consistent, easy-to-use electronic framework for transmitting claims documentation, improving efficiency across the entire healthcare system, the agency said.
Eliminating manual processes will help speed up claims processing and decision-making, ensure secure, authenticated electronic exchanges and streamline workflows for both providers and payers.
For administrative transaction data; this final rule adopts Version 6020 of the X12N 275 and X12N 277 standards as the finalized standards for healthcare claims attachments transactions.
For clinical data integration, the final rule adopts certain HL7 Implementation Guides (IGs) to provide a standardized framework for securely exchanging supporting documentation such as medical records, clinical notes and diagnostic results. The final rule adopts the HL7 Consolidated Clinical Document Architecture (C-CDA) IG Volume One, the HL7 C-CDA IG Volume Two and the HL7 Attachments IG, the agency said in the fact sheet.
The proposed rule included standards for both healthcare claims and prior authorization attachments, but the final rule focuses exclusively on healthcare claims attachments.
The Department of Health and Human Services will continue evaluating alternative standards for prior authorization attachments currently being tested by the industry, according to the fact sheet.
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