Medicare "Waiver" for Small Providers Billing on Paper
Sheila Press
Description
Collection
Title:
Medicare "Waiver" for Small Providers Billing on Paper
Creator:
Sheila Press
Date:
7/24/2003
Text:
FYI for List Serve Members:
On July 23, Palmetto GBA (DMERC C) published information regarding Medicare
electronic billing requirements. One of the HIPAA provisions of the
Administrative Simplification Act states that, effective October 16, 2003,
Medicare may not pay claims submitted on paper, with certain exceptions. A
major exception is for claims submitted by “a small provider of services or
a supplier.” We now know that the term, “small provider or supplier,” is
defined as: (1) a provider of services with fewer than 25 full-time
equivalent employees; and (2) a physician, facility or supplier (other than
provider of services) with fewer than 10 full-time employees. It is this
second definition that applies to O&P providers. The first part of the
definition apples to seven specific types of institutional or special
purpose providers.
Note that the publication of this information, on the Palmetto GBA web site,
contains a warning to those who bill by paper: This is not a “waiver!” If
you believe that you meet the small provider exception, you may continue to
bill on paper, but further instructions on changes to this process after the
regulations have been published. Of course, if you are not a small
provider, the recommendation is that you prepare to bill Medicare
electronically, if you are not already doing so, using the appropriate HIPAA
transactions.
Sheila M. Press, JD, MBA
Healthcare Compliance Solutions, Inc.
13653 East Aster Drive
Scottsdale, AZ 85259
Phone: 480-767-9477
Fax: 480-614-8782
Email: <Email Address Redacted>
Web: <URL Redacted>
On July 23, Palmetto GBA (DMERC C) published information regarding Medicare
electronic billing requirements. One of the HIPAA provisions of the
Administrative Simplification Act states that, effective October 16, 2003,
Medicare may not pay claims submitted on paper, with certain exceptions. A
major exception is for claims submitted by “a small provider of services or
a supplier.” We now know that the term, “small provider or supplier,” is
defined as: (1) a provider of services with fewer than 25 full-time
equivalent employees; and (2) a physician, facility or supplier (other than
provider of services) with fewer than 10 full-time employees. It is this
second definition that applies to O&P providers. The first part of the
definition apples to seven specific types of institutional or special
purpose providers.
Note that the publication of this information, on the Palmetto GBA web site,
contains a warning to those who bill by paper: This is not a “waiver!” If
you believe that you meet the small provider exception, you may continue to
bill on paper, but further instructions on changes to this process after the
regulations have been published. Of course, if you are not a small
provider, the recommendation is that you prepare to bill Medicare
electronically, if you are not already doing so, using the appropriate HIPAA
transactions.
Sheila M. Press, JD, MBA
Healthcare Compliance Solutions, Inc.
13653 East Aster Drive
Scottsdale, AZ 85259
Phone: 480-767-9477
Fax: 480-614-8782
Email: <Email Address Redacted>
Web: <URL Redacted>
Citation
Sheila Press, “Medicare "Waiver" for Small Providers Billing on Paper,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 6, 2024, https://library.drfop.org/items/show/221456.
