The proposed data standards aim to create a consistent framework to support the needs for electronic health data sharing, including healthcare claims, prior authorization transactions, and signatures.
By Sarai Rodriguez
December 21, 2022 – The Department of Health and Human Services (HHS) and Centers for Medicare & Medicaid Services (CMS) have proposed a new rule to implement data standards, which would improve the electronic health data-sharing process.
The proposed “Adoption of Standards for Health Care Attachments Transactions and Electronic Signatures, and Modification to Referral Certification and Authorization Transaction Standard (CMS-0053-P)” will specifically focus on “healthcare attachments” transactions, including medical charts, x-rays, provider referrals, and clinical documents.
Providers are required to fulfill health plan requirements to authorize healthcare services. Prior authorizations, for example, require providers to receive health plan approval before providing a patient with a specific service.
Often, health plans require a healthcare provider to submit information beyond the administrative data contained in a typical HIPAA transaction, such as medical documentation to support service claims or referral authorizations.
Typically, this additional information is needed so a health plan may make an administrative decision about payment for a covered service or a coverage decision about a service the provider intends to render.
When responding to these information requests, providers are forced to use manual processes like physical mail or web portal. These manual processes cause concerns for additional provider burden, HHS wrote.
The proposed rule is expected to significantly reduce administrative burden, streamlining the data sharing process and improving patient care. Additionally, CMS expects the rule to save $454 million annually in administrative costs.
“The proposals in this rule would provide a valuable tool to support the electronic submission of healthcare information,” CMS Administrator Chiquita Brooks-LaSure, said in a press release. “Healthcare providers are often forced to use manual processes such as mail, fax, or internet web portals when they respond to requests from health plans, leading to delays and less time for patient care. These important steps would promote more consistent and reliable communications among the partners involved in healthcare transactions, improving the care experience for all.”
Through HIPAA and the Affordable Care Act, the HHS Secretary is required to adopt a healthcare claim attachment standard. HHS recommends these new requirements for HIPAA-covered entities such as health plans, healthcare clearinghouses, and providers who regularly electronically exchange health data.
CMS and HHS also suggested modifications to the referral certification and authorization transaction standard to decrease barriers that limit value-based payment adoption, alleviate unnecessary administrative costs, and reduce burdens on providers and health plans.
“The proposed rule considers extensive stakeholder feedback and aims to support healthcare claims and streamline prior authorization transactions,” CMS stated in the press release. “By doing so, this rule would help make the process of submitting and adjudicating healthcare claims more efficient by providing structured, standardized electronic data to payers. The improved standards for electronic signatures will be used in conjunction with healthcare attachments transactions.”
HHS is accepting comments on the proposed revision until March 22, 2023, encouraging feedback from the public, patients, providers, health plans, and consumer advocates.
