General Surgery Coding Alert

Question: We operate a small surgical practice in a rural area, and we're having problems with our Medicare electronic claims submission process. What are our options until we get this fixed - holding a bunch of claims would be very difficult for us to sustain?

Iowa Subscriber

Answer: CMS does require that providers submit claims electronically, but there is an exception available for "small" practices, which you say that you are.

Option: You can file paper claims to Medicare if you meet the following definition of a small practice:

"Providers that have fewer than 25 full-time equivalent employees (FTEs) and that are required to bill a Medicare intermediary are considered to be small. Physicians and suppliers with fewer than 10 FTEs and that are required to bill a Medicare Administrative Contractor (MAC) or Durable Medical Equipment (DME) are classified as small."

Caution: For future growth and coverage issues, you should consider this a temporary solution and work to get your electronic claims submission process back up and running.