The Centers for Medicare & Medicaid Services on Friday announced plans to eliminate the use of faxes and snail mail, a move that would save taxpayers a projected $781 million.
CMS said it will soon seek to streamline healthcare payments by focusing instead on electronic transactions. While fax machines have largely disappeared from everyday life, many hospitals and radiology groups rely on the outdated technology to send clinical documentation supporting payment claims.
Under the final rule, CMS would establish national standards for the electronic exchange of such documentation. The agency said it plans to adopt new standards for e-signatures, aiming to ensure “secure, authenticated transmission of this information.”
“The 1980s called, and they want their fax machines back,” CMS Administrator and former TV personality Mehmet Oz, MD, MBA, said in a statement March 20. “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 healthcare by standardizing electronic claims attachments and enabling secure electronic signatures.”
CMS said the rule will officially take effect in 60 days, with covered entities having until May 2028, to comply. The agency contends its rule will establish a “consistent, easy to use” electronic framework for transmitting clinical documents to support claims. These often can include X-rays, clinical notes, telemedicine visit documentation and lab results. Despite the widespread availability of digital tools, radiology groups are often forced to use faxes due to reliability issues and Health Insurance Portability and Accountability Act compliance requirements, vendors note.
The new standards apply to all HIPAA-covered entities including health plans, healthcare clearinghouses and physicians. CMS touted other potential benefits that will include time savings, faster care delivery and enhanced security. The agency’s fact sheet offers further details on the X12 and Health Level 7 standards it will use beginning in two years.
An original proposed rule issued in 2022 included standards for both healthcare claims and prior authorization attachments. However, this final rule focuses solely on claims. Health and Human Services said it will continue to evaluate alternative standards for prior auth attachments, which are currently being tested by the industry.
Industry responses
The American College of Radiology said Monday it does not anticipate the change having a huge impact on the specialty. However, ACR said it will keep a close eye on the rollout for any potential implementation issues.
Meanwhile, the Radiology Business Management Association said Monday it appreciates any efforts to modernize administrative processes and “reduce reliance on outdated manual methods such as faxing and mailing.” The trade group also supports industry efforts to transition toward fully electronic communication for claims submission, records review requests and other documentation.
“Radiology groups nationwide already rely heavily on electronic transmission for filing claims and conducting routine interactions with Medicare,” Linda Wilgus, MBA, RBMA’s co-executive director, told Radiology Business March 23. “However, many practices have continued using manual processes when submitting supporting documentation and attachments because of limitations in current Medicare Administrative Contractor systems. For this reason, RBMA believes it is essential to better understand how CMS plans to implement this new policy and what technical standards will be used.”
The association urged CMS to clarify three aspects of rule implementation, which it believes are still unclear:
- MAC Readiness and Infrastructure: “Will all Medicare Contractors across the country have the necessary technology and secure systems in place to accept electronic attachments consistently and reliably? Past experience has shown considerable variation among contractors, and RBMA is concerned that uneven implementation could disrupt workflows and burden practices.”
- Impact on Claims Processing Timelines: “While the intent is to streamline processes, there is uncertainty regarding whether the transition will actually reduce administrative delays or potentially create new bottlenecks during the early stages of implementation. RBMA seeks assurance that the new approach will not slow down claims adjudication or medical review activities.
- Updated Requirements for Signatures: “Many MAC policies still require ‘wet’ signatures for certain forms or attestations. RBMA requests clarification on whether CMS will update these requirements to align with a fully electronic submission model, which would be essential for consistency and true administrative simplification.
“RBMA supports CMS’ goal of eliminating unnecessary manual processes and improving efficiency across the Medicare program,” Wilgus added. “We will continue monitoring implementation and compliance across all MAC jurisdictions, gather feedback from our members, and share any challenges or needed refinements with CMS.”