Is Health Care Ready to Be Fax Free by 2020?

Fax-machineThe Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma recently announced the goal of eliminating the fax machine in provider offices by 2020. She shared this news during the Office of the National Coordinator for Health IT (ONC) 2nd Interoperability Forum held in Washington, D.C. on Aug. 6-8, 2018.

Although this announcement seems alarming, this could be one of the steps needed to streamline the prior authorization process.

Studies Show Costs for Manual Prior Authorizations Are Higher than for Electronic

Recent studies by Council for Affordable Quality Healthcare (CAQH) indicate that 90 percent of communications between a provider and payer continue to be completed by phone or fax.

The CAQH Index assesses industry progress to reduce the use of manual transactions and eliminate cost. According to the 2017 CAQH Index 35 percent of prior authorization is fully manual (e.g. Telephone, Fax, Email), 57 percent is partially electronic (web portal or IVR), and 8 percent is fully electronic (ASC X12 278). A provider cost for a fully manual prior authorization transaction is $5.75, and for an electronic transaction is $2.55. That is a cost savings of $3.20 per transaction per provider.

Streamline Prior Authorization for Electronic Transactions, Says PAMED Physician

In May 2018, the Pennsylvania Medical Society (PAMED) was asked to provide testimony during a CIO Forum before the National Committee on Vital and Health Statistics (NCVHS) Subcommittee on Standards. The purpose of the Forum was to discuss the updates to HIPAA administrative standards and operating rules. 

Prior authorization – one of PAMED’s advocacy priority issues – was the focus of testimony shared by PAMED member and Past President James Goodyear, MD, FACS during the Forum.

To reduce paperwork and streamline provider billing and administrative functions, CMS and HIPAA established standards for electronic transactions. These standards and operating rules include electronic transactions such as claims and claim status, electronic remittance and payment advice, eligibility, prior authorization, referrals, coordination of benefits, and claims attachments. Although most of the standards have been adopted, they have not been updated since 2009.

Dr. Goodyear shared this testimony:

Authorization requests are where our practice and physician practices on a national level would like to see more innovation. This is an issue of high priority for both PAMED and the American Medical Association (AMA).  We need to see a more efficient approach for prior authorization of procedural care. In an age where we can attach consolidated clinical document architecture (C-CDA) to a direct secure message for a referral to another provider, how can we integrate this with our payers? Large and small physician groups hire additional staff to work on prior authorizations, and most requests continue to be fulfilled via fax, telephone, and even mail. I understand electronic prior authorization can be initiated by an electronic request or through a provider portal – for example, Navinet – but most follow up occurs by telephone or fax. This is an administrative burden and we ask that payers be held to the same standard as providers. The workload is unsustainable and interrupts patient care. Processes need to be streamlined and accountability shared equally between the two entities.

The prior authorization transaction, otherwise known as Accredited Standards Committee (ASC) X12 278 is mandated in the HIPAA Transaction and Code Set rule, but it is slow to be adopted. Eliminating the fax machine, may be considered a step in the right direction to bring all parties together to follow the same set of standards with regard to prior authorization. 

No Fax Friday on Oct. 12, 2018

In an effort to reduce the use of the fax machine, ONC’s Steve Posnack encouraged organizations to participate in “No Fax Friday” on October 12, 2018. Eliminating the fax is one of the ways providers leverage the EHR using the HIPAA 278 transaction exchanging necessary information initiating a prior authorization quickly and efficiently.

PAMED encouraged practices to take the ONC's challenge and then complete our brief survey to strengthen our advocacy efforts in Washington D.C. 

Additional Resources

More information regarding the 2017 CAQH Index Report can be found at: https://www.caqh.org/sites/default/files/explorations/index/report/2017-caqh-index-report.pdf

Dr. Goodyear’s complete written testimony can be found here.

To learn more about PAMED’s current advocacy priorities, including prior authorization, visit www.pamedsoc.org/advocacy.



7 comments

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  1. Joseph C. Paviglianiti | Sep 22, 2018
    While a noble effort, I think we would be better off getting rid of EHR than fax machines.  Despite spending millions and millions of dollars on EHR and IT support staff and IT technology, many hospital systems have several EHRs within their own systems that still do not talk to each other, let alone other health care providers outside of the system.  They still fax health records to these entities within their own system, as well as to providers outside the system.  If a health system cannot communicate within itself via EHR, we are nowhere near the utopian health info exchange that was dreamed about several years ago.  And, will warring / competing health care systems ever agree upon a workable method of HIE between themselves?  Until then, the fax machine is necessary, as patients navigate between providers in different health systems for their health care. Furthermore, only several months ago, a local health system had a ransomware attack, resulting in an inability to access EHR resulting in numerous canceled appointments, canceled procedures, and inadequate care of patients they did see due to lack of patient background info.  Their employed physicians complained in the news that they felt they were seeing patients "unsafely" without any background info.  These systems are hackable and this problem will only get worse.  Finally, PAMED is supposedly / hopefully working on some sort of statewide EHR (and clinically integrated network) that "the rest of us" (ie those of us in private practice who have resisted EHR for the above reasons) that hopefully will be a simple and LOW-COST generic option, to allow us to climb aboard the last train car as the runaway train of EHR lurches nearer the abyss.  Haven't heard where we are on that; hopefully will get update at annual PAMED meeting.  Until then, keeping my fax machine, not out of stubbornness, but out of necessity.
  2. Gregory Walter Romano | Aug 24, 2018
    Small independent practices are so often forgotten about.  Our fax machines are vital to our office workflow and i will NEVER get rid of it.
  3. Geoffrey B. Monsour | Aug 23, 2018
    I’ll keep my phone and fax machine thank you. They work , they’re inexpensive and we know how to use them.. AND they’re hack proof!!!! We are a small private practice and we enjoy the independence thatcomes with that and not the corporate medical rat race that my collegues are forced to deal with.
  4. Steve Karp | Aug 23, 2018
    And how much of our tax dollars were spent on this wonderful idea where nothing could go wrong? Over time, with fewer cats to herd, game over.
  5. Michael Feinberg | Aug 23, 2018
    But those of us with small practices are not required to use EHR, and sophisticated electronic prescribing software costs more than it is worth.  Electronic faxing works well for me and is not expensive.
  6. David A. Williams | Aug 23, 2018
    Not to mention website downtime - we continually have issues with UPMC's website being down for "maintenance" as well as Navinet.  Their technical support is only available during working hours whereas I perform a lot of my manual prior authorizations after hours when patient's are gone for the day.  I am also able to manually fill out prior authorization forms piecemeal when I have an opportunity.  If this were the case electronically, I would have to sign in to the website over and over and over again more than we do already.  Instead of finding new ways to increase burden on providers, why don't they legislate for increase transparency with insurance companies and discontinue all prior authorizations entirely.  That would save even more time and money!
  7. Holly C. Hoffman | Aug 23, 2018

    This idea would be less troubling if the current secure messaging systems actually worked. But in our 9-provider primary care group, we still find very few specialists enrolled in any type of secure messaging system. And in the few e-prior authorizations I have personally done, there were inadequate "reasons" given to be able to describe why the prior auth was needed. And if there WAS a selection that fit, when submitted, the system cycled you right back to where you started the process! 

     

    A LOT of bugs need to get worked out of this system and specialists need to be required to sign up for direct messaging before we can dream of being fax-free.

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