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Medicare Claim Submission Update

Medicare
in Medicare

MLN Medicare Billing 837P & Form CMS-1500

CMS has released a revised MLN Medicare Billing 837P & Form CMS-1500. A summary of changes is listed below:

  • There is a new tool that allows all transactions to be “checked consistently for compliance, syntax and business rules.”  Simply locate the log in screen via the ASSET page here.
  • Clarification provided on exceptions and waivers for individuals who file hard copy CMS-1500 claims. The Full-Time Equivalent (FTE) remains at less than 10. Exceptions were added for Medicare demonstration projects and mass immunizers.
  • Although you do not need to submit a waiver request if you meet an exception to file hard copy claims, it is vital that a clinic respond quickly to a letter requesting documentation. CMS states “Health care professionals or suppliers who don’t respond to a request for exception information get denied paper claims, effective the 91st day after the first letter date requesting documentation. Health care professionals or suppliers can’t appeal these decisions.”
  • There are additional circumstances added to the Waiver Request section, such as “Large group practice or supplier that submits less than 10 claims per month and not more than 120 claims per year.”

CMS adds the friendly reminder, “ We only accept claim forms printed in Flint OCR Red, J6983, (or exact match) ink.” The notice can be found here.

KMC University Library Members can find the updated resource in the Medicare Section under the lesson titled Medicare Billing and How It’s Different.Note, you need to be logged in as a member to access this lesson.

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