The Centers for Medicare and Medicaid Services (CMS) has finalized a rule aimed at phasing out faxed and paper-mailed medical billing documents.
The agency’s final rule, released Friday, will establish a national standard for the electronic exchange of clinical documents used to support medical billing. CMS said the rule also adopts standards for electronic signatures to ensure secure and authenticated transmission of this information.
This rule is called “Management Simplification.” Adoption of the final rule on standards for health insurance claim attachment transactions and electronic signatures will become effective on May 26. Organizations covered by HIPAA, including health insurance plans, health information clearinghouses, and healthcare providers that conduct electronic transactions, must become compliant by May 26, 2028.
CMS estimates that this rule will save the healthcare industry approximately $782 million annually.
“People in the 1980s were calling us wanting their fax machines back,” CMS Administrator Dr. Mehmet Oz said in a statement.. “The futuristic medical advances we’ve achieved, like augmented reality glasses that give surgeons X-ray vision, don’t have to coexist with administrative systems that are often decades behind the curve. This new rule will modernize American health care by standardizing electronic billing attachments and enabling secure electronic signatures, because every minute a provider saves on paperwork is an extra minute spent on patient care.”
The proposed rule was promulgated in December 2022 under the Biden administration.
According to 2020 data, it is estimated that 9 billion fax pages are exchanged in the healthcare industry each year. Fax machines are still commonly used throughout the industry today, and many healthcare providers continue to use them to exchange medical information.
CMS argues that relying on outdated, manual methods to submit additional claims-related documents required by health plans, such as medical records, X-rays, clinical records, telehealth visit documentation, and test results, results in delays and unnecessary costs.
The final rule establishes HIPAA’s first standards for health claims attachments and enables the secure electronic exchange of supporting clinical documentation related to health claims, such as medical records, radiographs, imaging tests, clinical records, telehealth visit documentation, and test results, the agency said in a fact sheet.
With the final rule, CMS aims to establish a consistent, easy-to-use electronic framework for submitting claims documents and improve efficiency across the health care system, the agency said.
Eliminating manual processes speeds claims processing and decision-making, ensures a secure and authenticated electronic exchange, and streamlines workflows for both providers and payers.
For administrative transaction data; this final rule has adopted version 6020 of the X12N 275 and X12N 277 standards as the final standard for health insurance claim attachment transactions.
For clinical data integration, the final rule adopts specific HL7 Implementation Guides (IGs) to provide a standardized framework for securely exchanging supporting documents such as medical records, clinical notes, and diagnostic results. The final rule adopts HL7 Consolidated Clinical Document Architecture (C-CDA) IG Volume One, HL7 C-CDA IG Volume Two, and HL7 Attachments IG, the agency said in a fact sheet.
Although the proposed rule included standards for both health insurance claims and preauthorization attachments, the final rule focuses only on health insurance claim attachments.
According to the fact sheet, the Department of Health and Human Services will continue to evaluate alternative standards for preauthorization attachments that are currently being tested in industry.
