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Facts about the cms 1500 pdf template

What Is the CMS 1500 Form and When Is It Used?

Like it or not, the increased need for healthcare has also increased our reliance on insurance to help pay for it. Handling the paperwork has become a monumental and expensive task. Automated systems have been created to make it easier for medical professionals to file claims. Insurance companies have also moved from paper to electronic forms. The change has resulted in higher efficiencies and improved accuracy for faster claims reimbursing.

What Is the CMS 1500 Form Used for?

The CMS 1500 form was developed by the Centers for Medicare and Medicaid. It’s also known as the Professional Paper Claim Form, and it replaces the HCFA 1500. This new and improved version has removed loopholes that were in the old form. The original claim form is red and white. Although some payers will accept copies of the form, most do not. The forms are scanned into a system that is programmed to recognize the Flint OCR Red. If the colors are not are not copied accurately, the automated system can’t identify the right fields on the form and may not input the information into the database correctly. If this happens, a claim may be delayed or denied.

Who Uses the CMS 1500 Form?

Noninstitutional healthcare service providers such as physicians and clinicians typically use this form to submit paper claims to Tricare, Medicare and Medicaid for reimbursement in place of the HCFA 1500. It’s also the standard form used by insurance carriers. If it’s not filed or filled out properly, the doctor or medical facility that submitted it will not be paid. The CMS 1500 form is interpreted through Intelligent Character Recognition. This enables the electronic system to extract the exact information this is needed for fast, cost-efficient processing. This benefits medical professionals in several ways:

  • Cost reduction over manual data collection
  • Controlled mechanism for aggregating the information
  • Increased accuracy of data entered into the system

When Should You Use the CMS 1500 Form?

If you are a medical professional who has a private practice but performs services at an outpatient facility or hospital, the CMS 1500 is used to bill for your services. Any healthcare services performed by an individual at a noninstitutional facility that meet insurance eligibility requirements can also be filed using this form. Claims for Medicare Part A and Part B care, regardless of where it was performed, must be submitted using this form for reimbursement. Although durable medical equipment can also be claimed using form CMS 1500, medical and outpatient facilities that use the equipment for services such as surgery, laboratory and radiology should use the CMS 1450 form. Nursing facilities, hospitals and in-patient medical facilities use this form, previously named UB-92, to apply to the insurance company for service reimbursement. Both form CMS 1500 and CMS 1450 are used to file for electronic claim reimbursement. The primary difference is that CMS 1500 is used by individual healthcare providers and CMS 1450 is used by medical facilities and institutions.

What Are the Consequences for Not Using the CMS 1500 Form?

The CMS 1500 is a universal claim form. It is accepted by insurance companies as well as Medicare and Medicaid for medical service reimbursement. Using the old form, submitting the claim on a photocopy of the form or not filling a form out completely can result in delayed or denied claims. These electronic forms are not mean to be filled out by hand. Even if you use this form but fill it out manually, it may not be processed. There are several other reasons a claim may be denied:

  • Invalid information – Data that is required on the claim, such as a PIN or NPI, is incorrect or expired.
  • Incomplete information – Necessary data is missing from the form.
  • Unprocessable claim – The form is missing required information, or the information that is included is not valid.

A particular piece of data may be required only if specific conditions exist. If such conditions are met and the necessary information is missing from a conditional field, the claim may be denied or considered unprocessable. In any of the scenarios listed above, a new claim form that is complete and accurate will need to be sent for processing.

Steps for Filling Out a CMS 1500 Form

CMS 1500 forms can be obtained from a variety of vendors. Make sure you are using the most recent version approved by the National Uniform Claim Committee. This ensures the data on the form can be efficiently processed when submitted.

  1. The form is used by a wide range of private health and government programs. Check the instructions for your specific program to ensure that you enter the right information needed to process the claim.
  2. Read through the instructions to make sure the required fields are filled in and that the information is correct.
  3. Code every billable service, with up to four modifiers, without unbundling procedures.
  4. Enter the conditional data as needed, such as another insured’s name, address, age, gender and policy number.
  5. Check the program instructions to make sure any data that may be considered optional by some providers is not a requirement for this one
  6. The CMS 1500 form is very detail-oriented and requires you to fill out the form precisely to receive reimbursement. Take the time to review all aspects of the form before submission.
cms-1500-pdf

Quick Questions

The healthcare system needed to keep up with technological advancements. It also needed to find some way to keep up with the increasing paperwork required for insurance claims. Electronic standardization was able to do both.

The old form only allowed for four diagnoses. The new format allows for up to 12 to be reported in item 21, but only one diagnosis can be linked to each line item.

There are two reasons. The first is that it contains a link to the NUCC URL and provides information about the form. The second is that it helps align the page in the scanner.

Resources
https://liveclinic.com/blog/cms-1500-form-medical-billing-important/
https://www.cms.gov/Medicare/Billing/ElectronicBillingEDITrans/1500.html
http://www.emrconsultant.com/emr-education-center/medical-specialty-guides/cms-1500-claim-form/

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