HHS Publishes Interim Final Regulation Requiring Medicare Electronic Claims Submission

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.

Posted to HIPAAcomply 8/18/03