Medicare Software

Written by Kimberly Clark
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Per federal mandate, as of October 16, 2003, all providers have been required to submit their Medicare claims electronically, in a HIPAA compliant format. HIPAA stands for the Health Insurance Portability and Accountability Act of 1996. Those qualifying small providers who requested and received an extension were temporarily exempt from this ruling.

Title II, Subtitle F of HIPAA, outlines provisions for standardizing and simplifying electronic healthcare transactions. When selecting Medicare software, it is imperative that you make sure it adherers to all the guidelines set forth in this section of HIPAA and that it has the ability to electronically transmit claims. Links to lists of HIPAA compliant software vendors can be found through the the Centers for Medicare and Medicaid Services (CMS).

The price tag on healthcare software ranges from vendor to vendor. In the early HIPAA implementation days, CMS required their Medicare contractors to provide free or low-cost software to healthcare providers to encourage early compliance with the regulations. However, the contractors only had to make sure that the claims submission process was HIPAA compliant.

Commercial Medicare Software Packages

As the healthcare industry as a whole moves toward becoming HIPAA compliant, providers are opting for commercial software packages which offer them more features. In addition to electronic claims submission, software has been developed specifically for integrating all billing and claims services, which involves tracking and receiving Medicare payments. There are also tools available with some programs that verify Medicare eligibility immediately while protecting patient information.


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Physician Billing Service

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