January 6th, 2016
By: Scott Kraft (Sun, Feb/16/2014)
One provision of the Affordable Care Act (ACA) that can work to your practice’s advantage is Section 1104, which gives you the right to insist on electronic funds transfer (EFT) as your method of payment.
As of Jan. 1, 2014, you are entitled to EFT payments upon your request under standards set by CAQH and implemented by CMS as part of the law. In addition, you are also entitled to receive standard electronic remittance advice (ERA) notices within three business days on either side of when you receive your EFT payments.
The ERA notices under the standard must also include the same control number or mechanism to help you link the payments to the remittance advice to track your payments. Providers are also able to quickly appeal any adjustments to claim amounts arising from denials.
CAQH has launched an EFT enrollment system that it hopes will end up as a standard EFT enrollment mechanism for providers to store the payment information needed for payers to facilitate electronic payments. The program has thus far attracted only two major payers, Aetna and Cigna.
While the ability to draw more payers to the EFT enrollment system launched by CAQH will make the EFT enrollment process more efficient and ultimately cheaper for your practice, the lack of participation by a payer doesn’t change the fact that the payer is required under the standard to offer a web-based enrollment system for CAQH.
The advantages to the practice are clear – a mix of paper checks and electronic payments is not an efficient way to track your revenue, and some payers, such as Medicare, require electronic payments in most cases. Even if your entire payment system was set up for paper checks, the system would still be less efficient to track than paper checks.
One of the keys to fully achieving the savings and efficiency gains of the EFT and ERA standards is to make sure your practice management system is able to receive the ERA notices so you can reconcile the remittance advice back to the money arriving in your bank account.
Check with your practice management vendor to see if your practice is currently equipped to receive ERA notices and, if not, what it will take to be able to do so.
If you can do that, your best bet is to get set up under ERA as quickly as you can with every payer – especially in an environment when some payers are using costly methods such as issuing debit cards to pay practices.
These cards can cost you 2%-4% of your revenue just to get access to your funds. Your practice should appeal or push back against any payer that claims a contractual requirement to accept payments by debit or credit card, given the existence of an EFT standard. CMS has not issued any guidance on whether the EFT standard might supercede any contractual arrangement you may have.