Are small provider practices exempt from the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Transactions and Code Sets regulations?

No. Regardless of practice size, all providers transmitting designated transactions electronically are subject to the HIPAA Administrative Simplification requirements. Effective October 16, 2003, small practices are exempt from the Administrative Simplification Certificate Act (ASCA) provision that excludes paper claims from Medicare coverage. Small practices will be able to continue to submit paper claims. ASCA defines a small practice or supplier as:

  1. A provider of services with fewer than 25 full-time equivalent employees or
  2. A physician, practitioner, facility or supplier (other than provider of services) with fewer than 10 full-time equivalent employees.

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Answer Summary: 
No. Regardless of practice size, all providers transmitting designated transactions electronically are subject to the HIPAA Administrative Simplification requirements. Effective October 16, 2003, small practices are exempt from the Administrative Simplification Certificate Act (ASCA)