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More news and manager tips can be found in the Members Only Section. To join LMGMA click here Small providers can bill by paper: The Administrative Simplification Compliance Act or ASCA includes a provision that states, effective October 16, 2003, Medicare may not pay claims submitted on paper, with certain exceptions. One of the major exceptions is for claims submitted by "a small provider of services or supplier." The term "small provider of services or supplier" is defined to mean:
The term "provider of services" is defined for Medicare by § 1861(u) of the Social Security Act to include seven specific types of institutional or special purpose providers. This term generally describes hospitals, nursing facilities and other institutional providers that are paid through Medicare fiscal intermediaries. The terms found in the phrase "physician, practitioner, facility or supplier" are used to describe entities that furnish Medicare services described in § 1861(s) of the Act, and are generally paid through Medicare carriers.There will also be other limited exceptions. Regulations clarifying the exceptions are expected to be published soon.If you believe that you meet the small provider exception, there is not a "waiver" for you to apply for at this time. Just continue to bill via paper. Further instructions on changes to this waiver process are to be provided after the regulations have been published. If you are not a small provider, it is recommended that you prepare to bill Medicare electronically using the appropriate HIPAA transactions. www.cms.hhs.gov/hipaa/hipaa2/ Website standardizes communications: This web site aims to standardize HIPAA communications between health plans and the provider community, including physicians, billing services, vendors and clearinghouses.The Workgroup for Electronic Data Interchange (WEDI) Strategic National Implementation Process (SNIP), co-chaired by MGMA, is an industry solution to the very real, very practical issues of interpretation and work flow inconsistencies surrounding implementation of HIPAA. Privacy Workgroup: LMGMA is proud to be one of the sponsors of the HIPAA Privacy Workgroupsand education network, headquartered in Baton Rouge. LMGMA members receive discounts on their programs and activities. What is HIPAA? Congress passed the Health Insurance Portability and Accountability Act (HIPAA) in 1996. There are four main areas that comprise administrative simplification:1. Electronic Transactions and code sets 2. Unique Identifiers 3. Privacy 4. Security What
are the HIPAA transactions? Electronic Transaction Standards
have been developed for the following exchanges of information that
providers conduct: What is a HIPAA covered entity? Under HIPAA, all health care clearinghouses, all health plans, and those health care providers that conduct certain transactions in electronic form or who use a billing service to conduct transactions on their behalf are considered covered entities. What is "electronic'? The term "electronic" is used to describe moving health care data via the Internet, an extranet, leased lines, dial-up lines such as for "direct data entry", or DDE, private networks, point of service, and health data that is physically moved from one location to another using magnetic tape, disk or CD media. For example, if a provider transmits information electronically by transmitting claims, conducting eligibility queries, conducting claim status queries or referrals, they would be considered a covered entity under HIPAA. Top
of page
October 16, 2003- Electronic Health Care Transactions
and Code Sets - all covered entities that filed for an extension
and small health plans CMS
has implemented a Listserv for HIPAA outreach materials.
This mailing list distributes information regarding HIPAA
announcements, educational material, roundtables, and other
related material. Effective June 1, 2003 this information
will only be distributed from the HIPAA Outreach Listserv.
To continue to receive these notices on HIPAA, please
sign up here To
register: CMS
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