Small Medicare Providers Submitting Paper Claims for PT, OT, SLP

#physicaltherapymedicare #occupationaltherapymedicare #speechtherapymedicare

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Here is content from CGS Website: Submitting Paper Claims
The Administrative Simplification Compliance Act (ASCA) requires that as of October 16, 2003, all initial Medicare claims be submitted electronically, except in limited situations. Medicare is prohibited from payment of claims submitted on a paper claim form that do not meet the limited exception criteria.

CMS has provided a listing of exceptions to electronic claim submission on its Administrative Simplification Compliance Act Self-AssessmentExternal Website Web page. Some of these include:

Small provider claims
Claims from providers that submit fewer than 10 claims per month on average during a calendar year
Claims for payment under a Medicare demonstration project that specifies paper submission
In addition, CGS has identified the following situations where it may be necessary for home health and hospice providers to submit paper claims:

Claims for dates of service that exceed Medicare timely filing guidelines
Claims that have been denied by the Federal Black Lung program and the provider is requesting Medicare payment. Refer to the Submitting Medicare Secondary payer (MSP) Claims and Adjustments Web page for additional information.
Prior to submitting any paper claims to CGS, home health and hospice agencies should conduct a self-assessment to determine if they meet one of the exceptions for electronic claim submission by accessing the CMS Administrative Simplification Compliance Act Self-AssessmentExternal Website Web page.

When appropriate, paper claims should be mailed to:
J15 — HHH Claims
CGS Administrators, LLC
PO Box 20019
Nashville, TN 37202

Here is the reference for Noridian: https://med.noridianmedicare.com/web/...

Here is the reference for Palmetto GBA: https://www.palmettogba.com/palmetto/...

Here is the CMS Reference: https://www.cms.gov/Regulations-and-G...

Let's look at the math behind paper claims.
1.) Buying paper claims and printing costs...
2.) Time at computer printing, packaging, mailing...
3.) Cost of mailing supplies and postage...
4.) Possible lost time in the mail not being delivered...

If you were to mail once a week you could save on time and packing supplies, but submitting electronically would allow you to submit daily. This allows you to catch problems faster.



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