Hello, October–goodbye, paper Medicare claims.
Oct. 1 marks the date that physicians and other providers may no longer submit any paper Medicare claims; electronically filed claims not in compliance with federal regulations are also prohibited.
The rules are part of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). After Oct. 1, paper claims will not be allowed, and all electronic claims “that do not meet standards required by [HIPAA] will be returned to the filer for re-submission as compliant claims,” the Centers for Medicare and Medicaid Services (CMS) announced in a statement. “Noncompliant claims will not be processed.”
The only groups that will be permitted to continue submitting paper claims are physician practices with fewer than 10 full-time employees and institutions with fewer than 25 full-time employees, according to a CMS spokesman.
As of June, only about 0.5% of Medicare fee-for-service providers were submitting noncompliant claims, CMS said.
However, that figure is a little misleading, according to Rob Tennant, senior policy advisor at the Medical Group Management Association.
“That doesn't mean [all] practices are submitting electronically; they're just getting claims to CMS electronically,” he said. “Lots of times providers will utilize a clearinghouse” that takes the providers' paper claims and transfers them into an electronic format for submission.
In addition, the CMS statement mentioned only compliance rates for claim forms, Mr. Tennant noted. Compliance in other electronic transactions, such as remittances, eligibility status inquiries, and claims inquiries, is much lower, he said. “These are all very important transactions from providers, and we're hearing from health plans and others that providers aren't there yet.”
As far as claims are concerned, most family physicians will be prepared to meet the Oct. 1 deadline–even the rural ones, according to David C. Kibbe, M.D., director of the American Academy of Family Physicians' Center for Health Information Technology.
The AAFP's membership surveys on information technology (IT) have found that more than 90% of its members have computers in offices for billing purposes, and 25% have electronic health records, Dr. Kibbe said. Those figures haven't been broken down with respect to rural versus urban, yet “people make the assumption that because a practice is small or rural, it's unlikely to use IT. That's just not true.”
Dr. Kibbe said recent visits to practices in North Carolina and Tennessee indicate that rural practices aren't behind the curve. “My staff and I made over 25 appearances at state chapter events, everywhere from Alaska to Hawaii, including some very rural areas, and we got a good feeling about what's happening in rural practices.”
Although many practices have found ways to comply with the HIPAA electronic claims submission regulation, the requirements do create a hardship for physicians in rural areas that aren't affiliated with large health care groups or hospitals that have the financial resources for a health IT system, Bernard Proy, M.D., a family physician in Corry, Pa., said. “If you're just a small rural practice, you don't have access to that kind of capital or technology.”
Establishing an electronic health record on your own can get costly–up to $50,000 to $100,000, he continued. “No one's paying to have that available, and that creates a difficulty.”
Dr. Proy's office does have an electronic billing system in place, but he's deferring from getting a full blown electronic health record system until he sees what kind of support the federal government will be offering.
Several bills in the Senate propose technology initiatives: Sen. Edward Kennedy (D-Mass.), Sen. Hillary Clinton (D-N.Y.) and Senate Majority Leader Bill Frist (R-Tenn.) have introduced legislation that would offer grants to financially needy providers to enhance their use of health IT, as well as financial assistance to establish regional health IT networks.
Another bipartisan bill from Sen. Debbie Stabenow (D-Mich.) and Sen. Olympia Snowe (R-Maine) would spur the use of new information technologies to reduce paperwork costs and improve patient care.
Until that legislation is approved, however, another solution might be to tap into existing resources, Dr. Proy said. For example, federal government agencies such as the Department of Veterans Affairs already have an electronic health record in place.
“Individual physicians could tap into that system–which has already been paid for with tax dollars,” he said. At press time, CMS was expected to shortly announce just such a program–a way for physicians to install a simplified version of the VA's electronic health records system at a very low cost.
Jennifer Silverman, associate editor for Practice Trends, contributed to this story.