CMS Publishes Interim Final Rule on Electronic Submission of Medicare Claims

 

The Centers for Medicare and Medicaid Services published (on Aug. 15, 2003) in the Federal Register its interim final rule implementing the requirement that Medicare claims be submitted electronically, in a format compliant with the Health Insurance Portability and Accountability Act, beginning Oct. 16.

The rule, mandated by the Administrative Simplification Compliance Act of 2001, identifies limited exceptions to the requirement, including roster billing of Medicare-covered vaccinations, the submission of dental claims and service interruptions beyond the control of the provider.

Also qualifying for exemption are providers with 25 or fewer employees, and physicians, practitioners and suppliers with 10 or fewer employees.

According to CMS, 139 million paper Medicare claims are submitted each year, 13.9% of all Medicare claims. The agency estimates that it will realize a savings of $1.40 per claim, or $95 million per year, as a result of the move from paper to electronic claims.

The rule can be found at:
http://www.access.gpo.gov/su_docs/fedreg/a030815c.html under Centers for Medicare & Medicaid Services.