Administrative Simplification Compliance Act Basics
Section 3 of the Administrative Simplification Compliance Act (ASCA), Pub. L. 107-105 and the implementing regulation at 42 CFR 424.32, require that all initial claims for reimbursement from Medicare be submitted electronically, with limited exceptions. The ASCA amendment to section 1862(a) of the Social Security Act prescribes that “no payment may be made under Part A or Part B of the Medicare Program for any expenses incurred for items or services” for which a claim is submitted in a non-electronic form.
For Medicare Part A facilities/providers, a small provider required to use CMS-1450 form when submitting claims on paper shall have fewer than 25 full time equivalent employees (FTEs) and supporting documentation is attached. (Acceptable documentation: Payroll Summary Report, tax forms [Quarterly 941 or Schedule C form], or signed letter on CPA letterhead with the number of employees noted.)
For Medicare Part B providers, a small provider required to use CMS-1500 form when submitting claims on paper shall have fewer than 10 full time equivalent employees (FTEs) and supporting documentation is attached. (Acceptable documentation: Payroll Summary Report, tax forms [Quarterly 941 or Schedule C.
To learn more about Health Care EDI and become a certified EDI Professional please visit our course schedule page.