Psychiatr News September 1, 2006
Volume 41, Number 17, page 13
© 2006 American Psychiatric Association
Psychiatric Practice & Managed Care APA Office of Healthcare Systems
and Financing
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Don't Take `No' For Answer
If you are a solo practitioner or work in a group practice with fewer than
10 full-time employees, you are defined as a "small provider" and
are not required to file Medicare claims electronically.
This reminder was prompted by a recent call to APA's Managed Care Help Line
from a psychiatrist in New Jersey. The psychiatrist had received a notice from
his Medicare carrier, Empire, that as of July 31 he would no longer be
permitted to submit paper claims—and that the decision could not be
appealed. The notice stated that the doctor had failed to respond to a letter
he had been sent earlier in the year requesting justification that he
qualified for the exemption allowing him to submit paper claims to Medicare.
As far as the psychiatrist knew, he had never received such a letter.
Ellen Jaffe, the Medicare specialist in APA's Office of Healthcare Systems
and Financing, contacted the office of Empire's medical director, Dr. Kathleen
Moynihan, to find out what the psychiatrist could do. He was a solo
practitioner with no employees. Dr. Moynihan's assistant implied that the
letter referred to in the notice may never have gone out and that he should
write a letter to the contact identified in the notice stating that he was a
physician with fewer than 10 full-time-equivalent employees and therefore
could continue to file paper claims.
The Administrative Simplification Compliance Act mandated that as of
October 16, 2003, all claims for Medicare reimbursement were to be submitted
electronically, with limited exceptions. Apparently an audit is under way to
ensure that those currently filing paper claims are, in fact, entitled to do
so. If you receive a letter from your Medicare carrier asking you to justify
your right to continue filing paper claims or stating that you can no longer
file paper claims, respond by explaining that you are a small provider with
fewer than 10 full-time employees.
If you have any questions about this issue, please contact the
Managed Care Help Line at (800) 343-4671. 
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