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Washington Highlights

HHS Issues Interim Final Rule for Electronic Claim Payments and Adjustments

September 7, 2012—The Department of Health and Human Services (HHS) Aug. 10 issued an interim final rule on the adoption of operating rules for health care electronic funds transfers (EFT) and electronic remittance advice (ERA) transactions. The regulation requires insurers to offer physicians and hospitals a standardized, online enrollment process for EFT and ERA claim payment transactions, aiming to reduce paper-based transactions and help foster electronic payments. HHS projects this rule will reduce “inefficient manual administrative processes” and create a net savings of between $300 million and $3.3 billion for physician practices, hospitals, and health plans.

The regulation builds on industry-wide EFT standards adopted by HHS earlier this year [see Washington Highlights, Jan. 13] and is the latest addition to the EFT & ERA Operating Rule Set. The rule set, required of HHS by Section 1104 of the Affordable Care Act (P.L. 111-148, P.L. 111-152), aims to streamline health care administrative transactions, encourage greater use of standards by providers, and make existing standards work more efficiently.

HHS projects the full rule set to save at least $2.7 billion over the next 10 years as well as 800,000 pounds of paper, citing research that 70 percent of health care claim payments are currently completed though paper-based processes.

The interim final rule requires all entities covered by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) to be in compliance with the EFT & ERA Operating Rules Set by Jan. 1, 2014. Comments on the interim final rule must be submitted to HHS by Oct. 9, 2012.


Rachael Gold
Health Care Affairs
Telephone: 202-828-0460


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Washington Highlights, a weekly electronic newsletter, features brief updates on the latest legislative and regulatory activities affecting medical schools and teaching hospitals.

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Jason Kleinman
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Telephone: 202-903-0806