Thursday, September 24, 2015

Paper Claims CMS-1500 (02-12)

Do's and Don'ts of Paper Claims

Do: Use original claim forms printed in red ink; photocopies and forms generated from ink jet or laser printers cannot be scanned.
Don't: Handwrite information on the document. Handwriting is only accepted for signatures. Handwritten clams require manual processing.
Do: Align the printer correctly so that characters appear exactly in the proper fields. Enter all information within designated fields.
Don't: Allow characters to touch lines.
Don't: Use broken characters (dot matrix), script, slant, minifont, or italicized fonts or expanded, compressed, or bold print. Use fonts that have the same width for each character (proportional).
Do: Keep characters within the boarders of each field. Use 10-pitch Pica or Arial or 10-, 11-, or 12-point type.
Don't: Strike over any errors when correcting or crowd preprinted numbers; OCR equipment does not read corrected characters on top of correction tape or correction fluid.
Do: Complete a new form for additional services if the case has more than six lines of service.
Don't: Use highlighter pens or colored ink on claims.
Don't: Use decimals in Block 21 or dollar signs ($) in the money column.
Don't: Use narrative descriptions of procedures, modifiers, or diagnoses; code numbers are sufficient.
Don't: Use N/A or DNA when information is not applicable. Leave the space blank.
Don't: Use paper clips, cellophane tape, stickers, rubber stamps, or staples.
Do: Enter 6-digit or 8-digit date formats, depending on the block instructions.
Do: Deep signature within signature block.
Don't: fold or spindle forms when mailing.
Do: Enter information via computer keyboard. Use clean equipment and quality ink-jet or laser printers.

Some Hints:

1.  ALL WORK ON A CLAIM FORM IS IN CAPITAL LETTERS.

2.  NEVER USE A DASH EXCEPT ON THE ZIP CODE

3.  SURGERY SERVICES ARE BILLED AS GLOBAL SURGERY.  THIS WOULD INCLUDE PREOP VISITS, HOSPITAL VISITS, HOSPITAL DISCHARGE AND POST OP OFFICE VISITS.  THE CHARGE FOR THE SURGERY INCLUDES ALL OF THESE CHARGES.
 
Block 14: Date of Current Illness, Injury, or Pregnancy (LMP) This block on the CMS-1500 identifies the first date of onset of illness, the actual date of injury, or the last menstrual period (LMP) for pregnancy. A qualifier code is used to determine which date it is. These codes are:
  • 431 Onset of Current Symptoms or Illness
  • 484 Last Menstrual Period

Internet Resources for The Paper Claim: CMS-1500 (02-12)


The Health Insurance Portability and Accountability Act of 1996 (HIPAA) From the Centers for Medicare & Medicaid Services.
The In's and Out's of Incident to Reimbursement Family Practice Management, November/December 2001.
Making Your Balance Sheet Work for You Online article on accounting methods from Family Practice Management, June 2001.
Manager's Electronic Resource Center Includes online resources and links covering many management topics for health services managers, including Financial Management. Produced by Management Sciences for Health with support from the U.S. Agency for International Development.
Professional paper claim form (CMS-1500) Information site from the Centers for Medicare and Medicaid Services.
Wisconsin Online Resource Center Select "Business", then "Accounting", to view interactive activities on specific accounting topics.
Agencies, Organizations and Associations
DFL Enterprises, Inc. Commercial site for CMS-1500 forms.
Medicare and Medicaid From the Centers for Medicare & Medicaid Services, formerly the Health Care Financing Administration. Includes a site on Coordination of Benefits Part D and Prescription Drug Coverage - General Information.
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