New federal rules to tighten the HIPAA transactions for electronic funds transfer and electronic remittance advice are on the near horizon.

The Centers for Medicare and Medicaid Services has sent an interim final rule establishing “operating rules” for EFT and ERA to the Office of Management and Budget. OMB review is one of the last steps before publication of a rule.

Industry stakeholders have been developing operating rules for several years and encouraging voluntary use. The Affordable Care Act mandates adoption of a series of rules between 2013 and 2016. These include operating rules for eligibility and claim status in 2013, EFT and ERA in 2014, and claims/encounters, coordination of benefits, enrollment/disenrollment, premium payments, attachments, and referral certification and authorization in 2016.

A recent Health Data Management Web seminar on ramifications of the Supreme Court health reform ruling, including the operating rules provisions, is available here.

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