The short answer is, "it depends."
It’s no surprise that healthcare payers prefer to receive claims electronically. Electronic transmission is more efficient, less prone to error, and much faster than a paper-based process. In some situations, however, electronically-submitted claims are not feasible.
Payers allow exceptions in these cases, and billers may submit paper claims. Most exceptions relate to the size of the provider or facility, or the number of claims they file per month. Below are the most common exceptions to electronic filing:
PROVIDERS WHO CAN SUBMIT THE CMS 1500 PAPER FORM
- Small providers:
- Facilities (who file Medicare Part A claims) with fewer than 25 FTEs; OR
- Physicians/Practitioners/Facilities (who file Medicare Part B or DME claims) with under 10 FTEs
- Large providers who submit fewer than 10 claims on average to Medicare per month.
- Providers who have experienced disruption in electricity or phone/communication services.
- Non-Medicare Managed Care Organizations that bill Medicare for copayments.
There are other exceptions related to types of claims – including, for example, dental claims. And, of course, paper claims from patients are also accepted.
For more detail on any of these exceptions – including how to count FTE’s to qualify as a “small” provider – see Chapter 24 of the Medicare Claims Processing Manual, Section 90 (the relevant information starts on page 81).
Happy billing!