Category Archives: final?

Final Rule for Electronic Submission of Medicare Claims

On August 15, 2003, the Department of Health and Human Services (HHS)
published the Final Rule for Electronic Submission of Medicare Claims.
This rule implements the statutory requirement found in the
Administrative Simplification Compliance Act (ASCA). ASCA requires
(with a few exceptions) all claims sent to the Medicare Program be
submitted electronically starting October 16, 2003.

ASCA was enacted by
Congress to improve the administration of the Medicare program by
increasing efficiencies gained through additional electronic claims
submission. Although 86.1 percent of Medicare claims are submitted
electronically, the volume of paper claims is substantial, and moving
from paper to electronic submissions has the potential for significant
savings for Medicare physicians, practitioners, suppliers, and other
health care providers, as well as for the program itself.

This Rule
sets forth the details for implementation of the Medicare electronic
claims submission requirement and who may be exempt from these
requirements.

The rule is available at:

http://a257.g.akamaitech.net/7/257/2422/14mar20010800/edocket.access.gpo.gov/2003/pdf/03-20955.pdf

The regulation requires that all claims submitted to Medicare on
October 16, 2003 and beyond be done so electronically except for certain
circumstances including:

The provider is a small provider

Dental claims

Claims where there is more than one payer primary to Medicare

Roster billing for vaccinations

Claims for Medicare demonstration projects

While these claims may be submitted electronically, they are not
required to be done that way.