Transactions Rule Now in Black and White

Baltimore

With only a few weeks to go before the provisions of a 1996 administrative simplification act take effect, health care providers across the United States are finding compliance to be anything but simple. Some of the confusion arose from conflicting information about how to comply, but an interim final rule that the Centers for Medicare and Medicaid Services published in the Aug. 15 edition of the Federal Register may have filled in a few of the blanks.

The interim final rule, in accordance with the Administrative Simplification provisions of the Health Insurance Portability and Accountability Act, explains that CMS will, as of Oct. 16, 2003, deny Medicare payments for services “for which a claim is submitted other than in an electronic form.”

Today, approximately 86 percent of the claims Medicare receives are electronic, CMS said. This means that providers submit approximately 139 million paper claims each year. If most of those claims arrived electronically, Medicare could save as much as $95 million annually, the agency explained.

Although the 18-page interim final rule allows few exceptions, it does describe situations in which CMS will waive the requirement:

• when there is no method available for submitting claims electronically (as is the case when beneficiaries submit claims directly to Medicare); and
• when the Secretary of the U.S. Health and Human Services Department deems a waiver appropriate.

To receive a discretionary waiver, providers must make a special request, the rule explained.

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