Aetna Pushing Digital Payment
By Christine Kern, contributing writer
Aetna will transition to all electronic payments in an effort to reduce waste and cut costs.
Health insurer Aetna announced it is transitioning providers to accepting 100 percent of payments electronically through an electronic funds transfer, as well all providers receiving electronic remittance advice.
Under the ACA, the healthcare industry is adopting “operating rules” that make the HIPAA transaction standards more uniform and include more information in the transaction sets. In January 2013, insurers were mandated to adopt the operating rules for insurance eligibility determination and claim status, and to adopt rules for EFT and ERA in January 2014. Although providers are not mandated to use the transactions, there is widespread consensus that they save time and money.
The Aetna statement read, “Over the years we’ve found many new ways to increase quality, reduce cost, and improve the health care experience for everyone. So when we learned that the health care system was wasting $190 billion dollars each year on paperwork and unnecessary administrative costs, we saw a real opportunity to make a difference using digital tools.”
According to a report from the policy journal Health Affairs, even small improvements in this area can produce dramatic gains in provider capacity. Physicians operating above capacity can diminish stress and burnout, while physicians operating below capacity will be freed up to take on additional patients. This move can help ensure work/life balance and financial stability for years to come, resulting in better access and quality for patients.
Health Data Management reported that this year, a growing number of insurers are requiring the providers to agree to go electronic with claims, eligibility, status, remittance advice, and payment transactions, says payor consultant Pat Kennedy, president of PJ Consulting Inc. However, the payors generally enable low-volume providers or those retiring in the next year or so to opt out.
For a variety of reasons, according to Kennedy, no payor will achieve 100 percent electronic payments, and a realistic goal for most is 90 percent. But while Aetna may consider hardship cases on an individual basis, it has changed its policy on payments and the goal is to have virtually all payments made electronically, says Jay Eisenstock, head of provider e-solutions. Every provider has a banking account, so the transition to electronic payments is not difficult, he adds.
“Aetna’s progressive initiatives supporting electronic funds transfer, electronic remittance advice and further electronic communications support the mandate for administrative simplification,” said Jeanne A. Gilreath, CHBME, president of the Healthcare Billing and Management Association (HBMA). “The HBMA applauds Aetna for being among the leading payors supporting technology advancements to reduce costs and ease the burden on the provider community.”
In recent years, Aetna has been increasingly offering EFT payments. Now with Medicare’s recent move to mandate EFT, Aetna knew the time was right to make its own move. Employees routinely are electronically paid these days and personal electronic banking is common, Eisenstock notes. While payors are required to offer EFT and ERA and benefit from it, the bulk of benefits come when providers take advantage of it.
For now, Eisenstock said that Aetna’s plan for EFT and ERA includes no penalties for non-compliance. But the insurer is changing its payment policy and at some point providers not going electronic will have to decide whether to keep their relationship with Aetna.