Does anyone still use fax machines for health care claims? If so, the Centers for Medicare & Medicaid Services (CMS) will no longer allow the outdated method and projects to save $781 million annually by establishing national standards for the electronic exchange of clinical documentation.
CMS on Friday released the Administrative Simplification; Adoption of Standards for Health Care Claims Attachments Transactions and Electronic Signatures Final Rule. It will be published in the Federal Register on Tuesday, March 24.
The 165-page final rule sets national standards for the electronic exchange of clinical documentation used to support health care claims and adopts standards for electronic signatures to ensure secure, authenticated transmission of this information. The rule takes effect on May 26, and covered entities (health plans, health care clearinghouses, and health care providers that conduct electronic transactions) must comply by May 26, 2028.
CMS estimates the new standards will save the health care industry $781 million a year.
“The 1980s called, and they want their fax machines back,” said CMS Administrator Dr. Mehmet Oz in an announcement. “The futuristic medical breakthroughs we’ve achieved, like augmented reality glasses that give surgeons X-ray vision, shouldn’t have to coexist with administrative systems that often lag decades behind. This new rule will modernize American health care by standardizing electronic claims attachments and enabling secure electronic signatures. Because every minute providers save on paperwork is another minute they can spend caring for patients.”
Historically, providers have relied on outdated manual methods to submit additional claims-related documentation to health plans, including medical records, X-rays, clinical notes, telemedicine visit documentation, and laboratory results. These methods cause delays and unnecessary costs. The new standards establish a consistent, easy-to-use electronic framework for transmitting this documentation, improving efficiency across the entire health care system, CMS said.
In addition to cost savings, the agency said the new standards will reduce administration burden and allow providers to focus on patient care; accelerate claims processing and decision-making; ensure secure, authenticated electronic exchanges; and streamline workflows for providers and payers.
Although the proposed rule included standards for prior authorization, the final rule focuses exclusively on health care claims attachments. The agency said in a fact sheet that it has held off on the proposed prior authorization standards due to stakeholders’ concerns of potential misalignment with existing X12N 278 transaction standard for prior authorization and potential conflicts with CMS’ Advancing Interoperability and Improving Prior Authorization Processes final rule. CMS said the Department of Health and Human Services will continue evaluating alternative standards for prior authorization attachments currently being tested by the industry.