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Operating Rules Have New Momentum

Now that the Supreme Court has upheld most of the provisions in the Affordable Care Act, the first round of Operating Rules will take effect in just a few months. There’s actually broad support for these rules because they standardize and simplify electronic healthcare transactions, so they’re likely to survive any efforts to repeal portions of the ACA.

And here’s the good news: many of you may have already done most of the work with eligibility and claim status rules because of requirements included in the 5010 transition. The ACA Eligibility and Claim Status Operating Rules that are required to be implemented by January 1, 2013 build on 5010 rules and changes, and they require even more standardization and robustness in the payer’s response to these requests for information which will help significantly reduce your claims denials arising from faulty eligibility data.

One of the changes is called the patient normalization rule, which is just a fancy way of saying that there will soon be a new data standard for titles like “Mr.” and “Mrs.” and surnames like “Jr.” and “III.” As you can imagine, this will result in far fewer claims denials because Frank Sinatra, Jr., won’t be confused with his deceased father and so on.

If your practice has had a bad experience trying to automate eligibility verification, don’t be discouraged. Things have changed dramatically in the last year alone, making implementation much easier. In fact, the faster you automate, the better. As the Operating Rules take effect in stages over the next few years, your practice will enjoy a number of benefits – like being better able to determine the patient’s portion of payment at the point of service.

There’s also another upcoming rule you’ll love that links bank transactions to remittance data, which, when used correctly, will free you from the time-consuming task of manually reconciling the two.

The ACA train slowly left the station in 2010 and is now gaining speed. The new Operating Rules will help you enjoy the ride.