Health Information Compliance Alert
PAPER VS. ELECTRONIC CLAIMS
Question:
Idaho subscriber
Answer:
On Oct. 1, 2005, CMS told you to say goodbye to paper claims. That was the date that physicians and other providers were told they could no longer submit any paper Medicare claims. The rules are part of HIPAA.There are some exceptions to this rule, however.Physician practices with fewer than 10 full-time employees and institutions with fewer than 25 full-time employees were permitted to continue submitting paper claims.
Important: You need to get special permission from Medicare before you use paper claims instead of electronic filing, however.
Caution: If you do decide to still send paper claims instead of using electronic claims submission, you may havetrouble proving timely filing. Most, if not all, payers are only accepting the electronic records as proof of timely filing.
Additionally: The Administrative Simplification Compliance Act (ASCA) prohibits payment of initial health care claims not sent electronically as of Oct. 16,2003, with some exceptions. You can find a list of the exemptions along with a self-assessment to determine if your practice qualifies for one of the exemptions online at www.cms.hhs.gov/ElectronicBillingEDITrans/05_ASCASelfAssessment.asp.
Best bet: Check with your Medicare carrier before submitting any paper claims to see if you qualify for an exemption and to find out the process you need to go through to obtain an electronic claim submission waiver.
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