The Centers for Medicare & Medicaid Services (CMS), on behalf of, the U.S. Department of Health and Human Services (HHS), issued the proposed rule, “Adoption of Standards for Health Care Attachments Transactions and Electronic Signatures, and Modification to Referral Certification and Authorization Transaction Standard (CMS-0053-P).” If finalized, the proposed rule, would adopt standards for “health care attachments” transactions, such as medical charts, x-rays, and provider notes that document physician referrals, and office or telemedicine visits. The modifications to the adopted Health Insurance Portability and Accountability Act of 1996 (HIPAA) transactions would support both health care claims and prior authorization transactions, standards for electronic signatures to be used in conjunction with health care attachments transactions, and a modification to the standard for the referral certification and authorization transaction. The proposed rule estimates a savings of $454 million annually in administrative costs and is a part of HHS’ and the Centers for Medicare & Medicaid Services’ (CMS) ongoing efforts to significantly reduce paperwork burdens and empower health care providers to focus on direct patient care and streamline the care experience for patients and providers.
“The proposals in this rule would provide a valuable tool to support the electronic submission of health care information,” said CMS Administrator Chiquita Brooks-LaSure. “Health care 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 health care transactions, improving the care experience for all.”
HIPAA and the Affordable Care Act require the HHS Secretary to adopt a health care claim attachment standard. HHS is proposing these new requirements on HIPAA-covered entities, which include health plans, health care clearinghouses, and health care providers who electronically transmit any health information in connection with transactions for which HHS has adopted standards.
The proposed rule considers extensive stakeholder feedback and aims to support health care claims and streamline prior authorization transactions. By doing so, this rule would help make the process of submitting and adjudicating health care claims more efficient by providing structured, standardized electronic data to payers. The improved standards for electronic signatures will be used in conjunction with health care attachments transactions. The rule also proposes to adopt a modification to the standard for the referral certification and authorization transaction, thereby reducing potential barriers to adopting value-based payments and significantly easing unnecessary administrative costs and burdens on providers and health plans.
The proposed rule is available to review here, and the deadline to submit comments is March 22, 2023. CMS encourages comments from all interested members of the public, and in particular, from patients and their families, providers, clinicians, consumer advocates, health plans, and health care professional associations.
For more information on the HHS proposed rule, please visit: https://www.cms.gov/newsroom/fact-sheets/administrative-simplification-adoption-standards-health-care-attachments-transactions-and-electronic