Requirement to file Electronic Claims

If you are submitting paper claims (HCFA 1500) to Medicare you may receive a letter from you carrier stating “[regulations] require that all initial claims for reimbursement from Medicare be submitted electronically with limited exceptions.”

One of the exceptions apply to small practices which is defined as one having fewer than 10 Full Time Employees (FTEs). This describes most chiropractic offices.

“A small provider can elect to submit all, some or none of their claims eletronically”

If you intend to continue to submit paper claims you must respond to the letter you receive with evidence to establish that you qualify as a small practice. Evidence might consist of copies of payroll records for all of your emplyees that lists the number of hours each worked during a specified period.

If you fail to respond
your carrier will begin to deny all paper claims you submit.

Once you are required to submit electronic claims, going back to paper claims is difficult.