Industry Insight

WEDI Issues Electronic Payments Guidance

The Workgroup for Electronic Data Interchange (WEDI), an authority on the use of HIT to create efficiencies in health care information exchange, announced the release of a wide-ranging set of industry best practices, entitled “Electronic Payments: Guiding Principles.” Developed by a multistakeholder ePayments Taskforce that included representatives from the health plan, provider, clearinghouse, banking, and government sectors, the guidance addresses concerns raised by respondents of WEDI’s electronic remittance advice/electronic funds transfer (ERA/EFT) survey in early spring 2016.

The ERA/EFT survey found that about 25% of provider organizations reported paying fees for use of the Automated Clearing House (ACH) EFT transaction. In addition, a full 40% were required to accept payment from a health plan in the form of a “virtual” credit card—a 16-digit credit card number sent to the provider for processing through their card terminal, with the provider responsible for all associated transaction fees. In establishing a consensus-driven set of principles that each impacted stakeholder can review and adopt through this document, WEDI anticipates driving increased use of ACH EFT, while at the same time establishing guidelines for the use of alternative payment options such as these virtual credit cards.

“WEDI’s mission is clear—identify opportunities for industry collaboration that lead directly to operational efficiencies in the health care environment,” says Charles Steller, WEDI president and CEO. “In support of that mission, we have developed the ePayments Principles to create a foundation for expanded use of the automated payment transaction, while at the same time instituting a framework for the appropriate use of alternative payment methodologies.”

“The benefits of using ACH EFT in health care are well established. The government estimates that the savings of using ACH EFT and ERA standards and operating rules is as much as $4.5 billion for government and commercial health plans, hospitals, physician practices and others over 10 years,” says Jay Eisenstock, head of provider solutions for Aetna and cochair of the WEDI ePayments Taskforce. “However, provider adoption has not been as rapid as many had hoped due to reluctance to modify existing workflows or purchase supporting software. We are hopeful that the ePayments Principles will serve as a catalyst for increased industry use of this important transaction.”

In addition to the general introduction to issues related to electronic payments and an outline of the various epayments federal mandates, the document identifies 14 recommended guiding principles to which all impacted stakeholders are encouraged to adhere regarding the implementation and ongoing use of epayments. The principles were developed to guide the industry in the use of all epayment methodologies and leverage the advantages of the administrative simplification opportunities associated with use of the ACH EFT and ERA standards and operating rules. Some key principles included in the guidance document include the following:

• A health plan, clearinghouse, or payment-related vendor should complete the ACH EFT enrollment process to facilitate ACH EFT payments within 30 days of receipt of provider enrollment information.

• Health plans, clearinghouses, and payment-related vendors should not delay ongoing payments when a provider elects to begin receiving any form of electronic payment.

• The provider should not be subject to any hidden fees. Before a provider may be paid via electronic payment, the health plan, clearinghouse, or payment-related vendor must: (a) notify providers regarding their fees associated with this payment method, (b) advise providers to check with any of their contracted vendors (ie, their credit card merchant processer) regarding any additional administrative fees, and (c) notify providers about the availability of an ACH EFT payment option.

• Before a provider may be paid via an epayment method other than ACH EFT, the health plan, clearinghouse, or payment-related vendor should receive explicit agreement (“opt-in”) from the provider.

• When a health plan or any of their clearinghouses or payment-related vendors offers an ACH EFT payment option, it should offer an ACH EFT option with no origination fees.

• There should be transparency from health plans, clearinghouses, and payment-related vendors regarding any required transition from paper-based payments to electronic payments, and providers should be given a minimum 90-day notice before the effective date of the electronic payment mandate and must opt-in to any nonstandard electronic payment method scheduled to replace a paper-based payment.

• Per NACHA Operating Rules, health plans, clearinghouses, or payment-related vendors must receive explicit authorization from the provider prior to use of the ACH EFT debit transaction for recoupment purposes.

“Despite the adoption of national standards aimed at decreasing administrative costs, providers are increasingly facing epayment transaction fees and expanded use of virtual credits cards. Combined, these serve as a significant impediment to widespread adoption of ACH EFT,” states Robert Tennant, director of HIT policy for the Medical Group Management Association and cochair of the WEDI ePayments Taskforce. “We expect that these ePayments Principles will serve as a guidepost for the industry and lead to further automation of the provider revenue cycle.”

— Source: Workgroup for Electronic Data Interchange

Verisma Joins AHIOS

The Association of Health Information Outsourcing Services (AHIOS), an organization of executives from the leading HIM outsourcing companies who promote excellence in managing risk and compliance issues around disclosure of protected health information, recently announced that Verisma has joined the growing association.

Based in Alexandria, Virginia, Verisma is an HIT provider focused on delivering patented, cloud-based release of information (ROI) automation solutions and services to health care organizations across the country. The company is a leader in technology-enabled ROI solutions, providing a compelling platform to aggregate and transfer secure patient data. Verisma’s ROI Automation System combines next-generation technology with highly trained teams of ROI, IT, legal, and business experts, enabling its clients to automate workflow, improve turnaround times, and decrease errors.

“Verisma is proud to be a member of AHIOS and contribute to the association’s mission of ensuring standards of excellence for the entire ROI industry,” says Marty McKenna, president and CEO of Verisma. “We are looking forward to working with AHIOS members in an exchange of ideas to elevate the landscape for HIM professionals and our client organizations.”

“We have entered a very challenging time in health care and with ever-increasing and complex compliance and quality assurance issues; the need for ROI outsourcing is greater than ever before,” says Stephen Hynes, president of AHIOS. “At this juncture, it’s crucial that the ROI industry comes together to deliver the highest-quality services and create a more efficient health care system amidst the changes of reform. Verisma is a wonderful example of a company that will strengthen our advocacy and education initiatives for the ROI industry and that will help us address complex quality assurance and compliance issues that are essential to the work of our member organizations and the entire health care industry.”

To view the complete list of AHIOS members, visit http://ahios.org/index.php/our-members.

— Source: Association of Health Information Outsourcing Services