Electronic Transaction Adoption Rates

CAQH CORE is the organization overseeing the adoption of HIPAA transactions as part of the ACA mandated adoption of these transactions. During 2013, the eligibility transaction (270/271) and the claim status transaction (276/277) became mandated for use by all HIPAA eligible entities. At the beginning of 2014, rules pertaining to EFT and the 835 electronic remittance came into effect.

CAQH CORE has reported the adoption rates for electronic transactions as of the end of 2013. These numbers represent the percentage of these transactions that are conducted electronically of the total of all transactions of these transaction types.

Transaction      Adoption Rate
Claims Submission 91%
Eligibility Verification 81%
Claim Status Inquiry 72%
Claim Payments 56%
Remittance Advice 53%
Prior Authorization 15%

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ICD10 to be delayed by one year

Yesterday, March 31, 2014, the senate passed a bill to delay ICD-10 implementation until 10/1/2015.  By a vote of 64 to 35, the Senate voted to delay ICD-10 by at least one year.  The bill is being sent to President Obama where his signature is expected.

This bill includes a suspension of Medicare’s Sustainable Growth Rate (SGR) formula, delaying a 24% cut in physician reimbursement, and delays the Medicare “two midnight” payment policy for hospitals until March of next year.  This was the original content of the bill, it is not clear how or when the ICD-10 delay later became part of this bill.

While the delay in implementing the new ICD-10 code sets helps organizations that were struggling to meet the 10/1/14 deadline, many organizations feel that this legislation is a big step backwards.  The bill actually states that the Department of Health and Human Services cannot adopt the ICD-10 code set until at least 10/1/15, allowing for possible further delays. Continue reading