April 8, 2022

New CMS Guidance on Virtual Credit Cards and EFT/ERA Payments

The Centers for Medicare & Medicaid Services has released new guidance on virtual credit cards and electronic funds transfer/electronic remittance advice payment transactions, as well as business associate compliance with the Health Insurance Portability and Accountability Act's administrative simplification requirements. The new guidance confirms the following policies for which organized medicine has historically advocated:

• VCCs may be used for payment but health plans may not force physicians to accept them. 
• As business associates to health plans, payment vendors must comply with the HIPAA-mandated transactions. 
• EFT value-add services may "adversely affect" the HIPAA-mandated standard transaction and thus health plans may not force physicians to accept them from a vendor as a condition of receiving electronic payments. 

Physicians should review the new guidance and talk to their health plans about any services they are currently receiving that they do not want. Physicians should distinguish between fees their own business associates may provide and fees the health plan requires. Additionally, physicians filing a complaint via the CMS Administrative Simplification Enforcement and Testing Tool should be sure to name the health plan in their complaint, as the health plan is ultimately responsible for compliance with HIPAA.

This update courtesy of the American Medical Association.