Medicare Compliance & Reimbursement
CMS Offers Claims Exceptions for Small Practices
Tip: Medicare will accept paper claims, but there are size restrictions. Question: Our practice recently reorganized, and we now only have 11 full-time employees. We are having an issue with our electronic claims submission software and heard that small practices can send claims via paper, but we don't have confirmation of that. Can you advise? Codify Subscriber Answer: Although CMS requires practices to submit claims electronically, there are exceptions to this rule, and small providers can meet one such exception, allowing them to submit paper claims. According to CMS, the small provider claims exception applies to physicians, suppliers, and other providers of healthcare services under the following circumstances: "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." Therefore, you should be fine submitting a paper claim to your insurer without having to request a waiver.
Medicare Compliance & Reimbursement
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CMS Offers Claims Exceptions for Small Practices
Tip: Medicare will accept paper claims, but there are size restrictions. Question: Our practice recently reorganized, [...] - Industry Notes:
Consider New DOS Guidance for Lab Tests From CMS
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