Ophthalmic practices have reported that health plans are opting to pay claims by virtual credit card (VCC), which can result in added practices expenses from processing fees.

If your practice does experience this, be aware of the payment terms in each plan’s contract and key regulatory provisions for electronic health care electronic funds transfers (EFT) and electronic remittance advice (ERA) transactions.

The Department of Health and Human Services has provided guidance (PDF) for covered entities that conduct electronic transactions using the EFT and ERA standards adopted citation at 45 C.F.R. § 162.1602(d) . Issuing a payment through wire transfer, VCC, or automated clearing house (ACH) network meets the regulatory definition of an EFT transmission. However, HHS has only adopted standards that apply to EFT transmissions through the ACH network.

The frequently asked questions posted on the Centers for Medicare & Medicaid Services (CMS) website related to the guidance clarify that practices do not have to accept VCC, and if requesting payments through the adopted standards of the ACH network using electronic funds transfer (EFT), the health plan is required to comply with the request. To receive EFT payments through the ACH network a provider must complete EFT enrollment with the health plan. Physicians do not have to be contracted with a health plan’s network or otherwise affiliated with the health plan.

What if the practice requests a paper check? The Health Insurance Portability and Accountability Act of 1996 (HIPAA) does not require the health plan to comply with a request for payment via a paper check.