Smart Talk: Say goodbye to paper claims

Sunday, July 31, 2005

Q. Is it true that Medicare is only accepting electronic claims beginning in July 2005?
A. Effective July 1, the DMERCs began enforcing the Administrative Simplification and Compliance Act (ASCA). ASCA requires all providers to bill claims electronically in a HIPAA compliant format. The three major exceptions to this rule that allow you to submit paper claims are:
- Providers with less than 10 full-time employees (FTEs);
- An act of nature or technical problem that prevents you from sending electronic claims;
- If you need to communicate more information to the DMERC than can be accommodated in an electronic format -- for example, a narrative that is longer than 80 characters.
However, if you do not meet these exceptions, the DMERCs will have the authority to return or reject your claim as unprocessable. Enforcement will be primarily based on statistical analysis at first. The biggest offenders or highest submitters of paper claims will be contacted to verify if an exception applies. If it is determined that the provider does not qualify for an exception, all future paper claims for that provider number will be returned or rejected. This decision will not be subject to appeals. Ultimately, filing claims electronically should be your default choice because of the faster 14-day turnaround. But, if you have a legitimate reason to submit by paper, you should not worry that it will be rejected. One common misconception among providers is that Medicare Secondary Payer (MSP) claims must be submitted hardcopy. However the HIPAA compliant format allows for data entry on a line-by-line level of MSP data. If you are still submitting these by paper, talk with your software vendor to find out how these claims can be transmitted electronically.


Andrea Stark is is a Medicare consultant/billing specialist at MiraVista. Reach her at (803) 462-9959/