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Medicare Liason Report

Alfred H. Moffit, Jr., MD - Medicare Representative

The last meeting of the Carrier Advisory Committee was on June 3, 2006 in Orlando. As the Centers for Medicare and Medicaid Services (CMS) continues to seek new and innovative methods of reducing the cost of administering the Medicare program, one immediate focus is on the reduction of paper handling. In an effort to prepare for future changes and to proactively support the provider population, First Coast Service Options, Inc. (FCSO) is initiating a campaign to help providers reduce the volume of paper claim submissions.

ASCA—Required Electronic Submission
One current CMS initiative that already supports this effort is the Administrative Simplification and Compliance Act (ASCA). Some providers have already received letters requiring that documentation be provided to attest to your qualifications relative to meeting one of the exception criteria to be excluded from filing paper. If you have received a letter, we strongly encourage you to respond timely in order to avoid unnecessary paper claim denials (beginning 90 days from the date of the initial letter) as a result of “no reply” situations. To find out more about ASCA, visit the EDI section of the Florida Part B website at: http://www.floridamedicare.com/edi_local_asca.asp.

Of significant benefit to you, in converting from paper to electronic claims submissions, is the difference in payment schedules between paper claims and electronic claims. As you know, the CMS recently made a change to increase the paper claims payment floor by 2 additional days, from 27 to 29 days. This will result in checks being mailed 2 days later than they were previously. At the same time, the CMS removed the contractor performance requirement to process all clean paper claims in 30 days. This could result in additional delays in processing paper claims. If you file electronic claims, you are held to a different payment floor of 14 days. This results in a much faster turn-around on claims payments.

In summary, if you need additional information on what you need to do to convert to electronic claims filing, please contact the EDI department at (904) 791-8767 or visit the EDI section of the Florida website at: http://www.floridamedicare.com/EDI_Home.asp.