CMS Issues FAQs on Providers' Rights Regarding Healthcare EFT Standard

In response to industry questions regarding health plans or their vendors' ability to charge providers a percentage of the transaction value to receive the healthcare EFT standard (CCD+Addenda), CMS issued FAQ 9778 that states that a health plan may not:

  • Delay or reject an EFT or ERA transaction because it is a standard
  • Charge an excessive fee or otherwise give providers incentives to use an alternative payment method to EFT via the ACH Network

Providers who choose not to use the ACH Network may continue to receive payments by check, Fedwire, and other payments networks.

For any payment method, CMS recommends that providers carefully review the agreement for any added fees. 

NOTE: CMS has been requested to define “excessive fees” and is currently reviewing the term in relation to HIPAA violation reports that have been filed.  The definition of excessive fees and health plans charging providers to deliver the healthcare EFT standard (CCD+Addenda) was also a topic of discussion at the National Committee on Vital and Health Statistics (NCVHS) Subcommittee on Standards hearing in June. Several panel participants requested that NCVHS prohibit health plans from charging providers to deliver the healthcare EFT standard or require them to have a free healthcare EFT option available and published for providers.