Home Health & Hospice Week

More than 10 employees could prevent you from qualifying for a HIPAA exception.

If you're not ready to go electronic with your Medicare claims by Oct. 16, you can wave good-bye to your Medicare payments.

When the Health Insurance Portability and Accountability Act transaction rule deadline hits, if you don't submit your claims electronically, in virtually every circumstance you won't get paid.

The Centers for Medicare & Medicaid Services has made that clear in an Aug. 15 interim final rule. The rule formally requires that Medicare claims be submitted electronically starting Oct. 16, with only a handful of exceptions.

The biggest exception is for small providers and suppliers. CMS defines "small" entities as either a) a provider of services with fewer than 25 full-time equivalent employees (a home health agency or hospice), or b) a physician, practitioner, facility or supplier with fewer than 10 FTEs (durable medical equipment suppliers).

The rest of the exceptions will be quite rare. They include circumstances in which there is no method available for the submission of an electronic claim (roster billing of vaccinations falls into this category); dental claims; and claims submitted during a service interruption that's beyond the control of the organization submitting the claim.

Organizations also can appeal for special waivers by applying to their carrier or fiscal intermediary, says the rule, at www.access.gpo.gov/su_docs/fedreg/a030815c.html.