Which provider group is exempt from submitting electronic claims to Medicare?

The choice indicating that single provider clinics are exempt from submitting electronic claims to Medicare is valid because the Centers for Medicare & Medicaid Services (CMS) recognizes that smaller provider practices, such as single provider clinics, may not have the same technological capabilities as larger institutions. These facilities often face financial and operational challenges that make it difficult for them to transition to electronic submission.

Consequently, acknowledging their specific circumstances, CMS permits these clinics to submit paper claims instead of the mandated electronic claims that larger practices and hospitals typically must file. This exception aims to reduce the administrative burden on smaller healthcare providers while still ensuring they can receive payment for their services.

In contrast, larger provider groups, emergency care units, and outpatient services generally have the resources necessary to manage electronic claims efficiently and are thus obligated to comply with electronic billing requirements.