AMA CPT® Assistant - 2013 Issue 7 (July)
Bulletin 2013: The Continuation of Administrative Simplification in the Affordable Care Act (Juiy 2013)
July 2013 page B1 Bulletin 2013: The Continuation of Administrative Simplification in the Affordable Care Act While the Patient Protection and Affordable Care Act of 2010 (ACA) garnered much skepticism and criticism from the public and the general health care industry, proponents of administrative simplification were pleased with the inclusion of several provisions that would continue to build on the work of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Administrative simplification, through the use of standard transactions and automated processes, delivers on saving practices time and money. The expanded requirements put forward in ACA will give...
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Article Overview
This bulletin explains how Affordable Care Act administrative simplification provisions extend and update HIPAA electronic transaction standards. It is relevant to physician practices, billing staff, practice managers, compliance teams, and vendors that handle electronic claims-related workflows. The article covers broad categories of guidance on operating rules, EFT, claim attachments, health plan identifiers, and health plan certification, along with implementation timing and administrative impacts.
Why This Topic Matters
The topic matters because it affects how practices and health plans exchange administrative data, manage workflow efficiency, and prepare for compliance-related changes. Understanding the article helps readers track federal administrative requirements that influence electronic billing and payer interactions.
Article Sections
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Administrative Simplification Under the ACA
Introduces the article’s focus on ACA administrative simplification and its relationship to HIPAA. Summarizes the major subject areas addressed in the bulletin.
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Operating Rules
Explains the purpose of operating rules, their relationship to standard transactions, and the general implementation framework. Also discusses organizations involved in developing the rules and the role of compliance timing.
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Overall Operating Rules
Describes requirements that apply across multiple electronic transaction types. Covers general administrative features intended to support consistent exchange processes.
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Eligibility for a Health Plan
Addresses the eligibility transaction and the related operating rule framework. Focuses on the administrative effects for practices and payers.
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Health Claim Status
Summarizes the operating rule considerations for claim status transactions. Discusses standardization themes and workflow consistency.
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Health Care Payment and Remittance Advice and EFT
Covers the combined treatment of remittance advice and EFT-related operating rules. Describes enrollment, standardization, and payment reconciliation topics at a broad level.
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EFT Standard
Reviews the electronic funds transfer standard and its administrative role in health care payment workflows. Notes its relationship to broader transaction standardization efforts.
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Health Claim Attachments Standard
Introduces the claim attachment standard and the shift from manual to electronic exchange. Discusses supporting documentation and implementation context.
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Health Plan Identifier
Explains the health plan identifier initiative and related identifier standardization efforts. Includes discussion of entity identification and administrative transaction efficiency.
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Health Plan Certification
Summarizes the requirement for health plans to certify compliance with electronic administrative standards. Also addresses oversight and compliance emphasis.
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Timeline of Compliance Dates
Provides a compliance-date overview for the requirements discussed in the article. Organizes the timing of implementation milestones.
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What Practices Can Do
Discusses practical implementation considerations for practices and their vendors. Focuses on preparation, workflow support, and general readiness steps.
What You Will Learn
- The major ACA administrative simplification topics affecting electronic health care transactions
- How operating rules relate to HIPAA standard transactions at a general level
- Which broad workflow areas are impacted by EFT, claim attachments, identifiers, and certification requirements
- How compliance timing and implementation planning are presented for practices and vendors
- The role of payer and practice administrative processes in electronic transaction standardization
Who Should Read This
- Physician practices
- Billing staff
- Practice managers
- Compliance personnel
- Clearinghouses and vendors
- Health plan administrative staff
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