Don't Take `No' For Answer

If you are a solo practitioner or work in a group practice with fewer than 10 full-time employees, you are defined as a “small provider” and are not required to file Medicare claims electronically.

This reminder was prompted by a recent call to APA's Managed Care Help Line from a psychiatrist in New Jersey. The psychiatrist had received a notice from his Medicare carrier, Empire, that as of July 31 he would no longer be permitted to submit paper claims—and that the decision could not be appealed. The notice stated that the doctor had failed to respond to a letter he had been sent earlier in the year requesting justification that he qualified for the exemption allowing him to submit paper claims to Medicare. As far as the psychiatrist knew, he had never received such a letter.

Ellen Jaffe, the Medicare specialist in APA's Office of Healthcare Systems and Financing, contacted the office of Empire's medical director, Dr. Kathleen Moynihan, to find out what the psychiatrist could do. He was a solo practitioner with no employees. Dr. Moynihan's assistant implied that the letter referred to in the notice may never have gone out and that he should write a letter to the contact identified in the notice stating that he was a physician with fewer than 10 full-time-equivalent employees and therefore could continue to file paper claims.

The Administrative Simplification Compliance Act mandated that as of October 16, 2003, all claims for Medicare reimbursement were to be submitted electronically, with limited exceptions. Apparently an audit is under way to ensure that those currently filing paper claims are, in fact, entitled to do so. If you receive a letter from your Medicare carrier asking you to justify your right to continue filing paper claims or stating that you can no longer file paper claims, respond by explaining that you are a small provider with fewer than 10 full-time employees.

If you have any questions about this issue, please contact the Managed Care Help Line at (800) 343-4671. ▪