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 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
- 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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