The increasing demand for healthcare and the increasing dependence on insurance for payment for services rendered has led to the creation of systems, which can ease the burden of the healthcare service provider. Increasing use of insurance by people means that the healthcare professional or provider has to maintain detailed information regarding the patient, his or her medical history, treatment and also the exact nature of the claim from the insurance company.

Insurance forms have undergone major changes over the years, with the major change coming in the form of electronic claims forms as opposed to the traditional paper claims. This change has ensured better accuracy, efficiency of filing as well as enhanced speed in reimbursing claims. Previously, healthcare service providers were using the HCFA 1500 form to process their claims. This has been rendered obsolete recently with the introduction of the new CMS 1500 claim form. Industry experts say this is a better version of the earlier form, and all the earlier loopholes are now plugged.

What is CMS 1500 Claim Form?

The CMS 1500 Claim Form is the standardized form used by non-institutional healthcare service providers who are seeking reimbursements from Medicare. It is pertinent to note that such healthcare providers are waived under the Administrative Simplification Compliance Act from being required to fill electronic claims. This form has been modified from the earlier version to include information regarding National Provider Identifier or NPI, which was not there in the earlier format.

These CMS 1500 claim forms are easily available at the US Government Printing Office, office supply stores and with local printing companies across the country. The CMS 1500 Claim forms are available in single part, multi part, laser, continuous feed, which make it easy for you to choose from, depending on the printer you have as well as your requirement.

Key points of CMS 1500 Claim Form
The CMS 1500 claim form is interpreted and computed by means of a technology known as the Intelligent Character recognition or ICR, which helps the computer to gather correct and exact information from the form. The advantages of this technology are:

  • Enhanced accuracy of data collation
  • Enhanced efficiency
  • Controlled manner of feeding data
  • Cost reduction

This software ensures that data is quickly captured from the claims forms and processed and verified against other data before final approval. However, it is important to remember that for the software to be accurate, the data in the forms should be accurate and legible.

Difference between CMS 1500 and HCFA 1500

Medicare forms have undergone tremendous changes over the years in order to ensure better efficiency and accuracy of information provided to the company. As mentioned above, most medical practitioners were using the HCFA 1500 claim form for many year. However, recently the government felt the need to change the existing form and create a new version; the CMS 1500 is projected to be superior of the earlier claim forms. Major changes included change in the language – either deleting or adding or modifying, and also change in the format of the boxes, including size, amongst other changes. The following changes can be called the major areas of change in the new CMS 1500 form:

  1. Inclusion of NPI Number or National Provider Identifier Number is perhaps the most important change that has happened in this form. The new form helps record the NPI number separately in a different box, unlike its predecessor, where everything was together, which often caused confusion.
  2. Removal of barcode from the header to allow space for noting the address of the payer
  3. The tag line “please do not staple in this area” was removed. Now you can attach your supplements at the top center of the claims forms.
  4. The field ‘type of service’ that was present in the earlier forms was removed in the new CMS 1500 as the companies felt that there was no need for such information. Instead the field is now called EMG.
  5. In the new CMS 1500 form, you will no longer see the words ‘reserved for local use’ as the same has been removed.
  6. The field ‘Tricare’ has been added above the field ‘Champus’ in the first box.
  7. Lastly, the website address from where form fillers can obtain the NUCC instruction manual is added in the new CMS 1500, thereby making it easy.

These changes, though relatively small, are significant. Therefore, it is important that you take care of it while filling in your forms.

Tips on filling CMS 1500 Accurately
Accuracy and exactness of information are very important when filling Medicare claim forms. Moreover, it is important to ensure that all fields are duly filled, in order to ensure completeness of the form. Given the novelty of the CMS 1500 and the multiplicity of fields, filling such a form can be quite daunting, especially to someone who is new to the field. The following tips will help you fill your CMS 1500 both successfully as well as accurately:

  • Always use fonts like Pica or Arial for filling these forms, with font size anywhere between 10 and 12.
  • Fill the form in capital letters and always use black ink or black colored font.
  • Never use italics, or broken characters, stylized fonts, dot matrix fonts or red ink while filling CMS 1500 forms.
  • Ensure that the data you enter is in the middle of the box and does not touch the edges.
  • Use standard codes for various fields and never use any narrative text.
  • Remember that the size of the form you submit is 8½” x 11″. So, make sure that you tear off all perforations. Additionally, it is important that you ensure that all other attachments to the form are smaller than the size of the form.
  • Never use stickers or rubber stamps with your name and address on the form.
  • Don’t fill any special characters like hyphens, ditto marks, periods, dollar signs etc on the form.
  • Ensure that you submit the form in original while keeping a photocopy for your reference. Any form not submitted in original will not be processed.

In addition to these formatting requirements, there are certain aspects of form filling, which must be considered if you want immediate and correct payment for your services. These include:

  • Ensure that all relevant fields are properly filled in the manner it should be filled.
  • Use appropriate codes to fill patient medical details. Details can be taken from the personal data of the patient that was collected during examination.
  • It is important to accurately enter fields like date of birth of patient, the health insurance number etc.
  • The names of both the insured as well as the patient should be entered correctly. Often it happens that the insured person is not the patient and in such cases, it is important to enter the name of the insured in the box earmarked for the same.
  • Section 11 of the CMS 1500 claim form is mandatory and must be filled as it determines whether the patient is covered under Medicare or not.
  • Lastly, ensure that the form is signed by the patient along with the date and once this is done, it can be submitted as per hospital rules and regulations.

Given the fact that many patients are covered under Medicare, it is important to ensure that each filing is given due care and time, in order to ensure accuracy of filing and immediacy of reimbursement. Following the simple tips given above will actually help in filing correct claims, which in turn will increase efficiency and ultimately increase profitability of the healthcare facility.

If you would like assistance with your Medical Office Billing, we will be happy to provide you with some suggestions. And you may wish to learn why an Outsourced Revenue Cycle Management company may be most appropriate for your medical office.

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