CMS 1500 Form 02/12 - PowerPoint PPT Presentation

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CMS 1500 Form 02/12

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  1. CMS 1500 Form 02/12 Steve Verno, CMBSI, CMSCS, CEMCS

  2. Disclaimer I am NOT a Lawyer! I DO NOT provide Legal Advice! I DO NOT answer, “Is It Legal?” questions I AM a Coder and Medical Biller! This presentation is for Training Purposes. The Information in this Presentation came from The National Uniform Claim Commission (NUCC) CMS 1500 Instruction Manual

  3. What will NOT be discussed! Current or Past Claims Issues! Coding or Billing Problems You are Having! Legal Issues! Software problems! Rumors or Office Debates!

  4. What WILL be discussed! Changes to the CMS 1500 Form! When it may be necessary to use a Paper CMS 1500 Form

  5. CMS 1500, 02/12 is Effective April 1, 2014

  6. The 02/12 Form has MANY Changes!

  7. 0805 0212

  8. When might you send a paper claim?

  9. The Computer System is Down!

  10. The Doctor still sends all claims by mail!

  11. The Insurance Company cant accept Electronic Claims!

  12. The Court Ordered The Insurance Company to pay an old claim and* The original billing company is out of business

  13. CMS 1500 02/12

  14. Brought to you by…

  15. Changes will be identified by an arrow:

  16. Pay Attention Symbol!

  17. Boxes 1 through 13 are prepared based on information provided by the PATIENT/INSURED

  18. Valid Condition Codes W2  Duplicate of original bill W3  Level 1 appeal W4  Level 2 appeal W5  Level 3 appeal

  19. Boxes 14 through 33a/b are based on the patient encounter/visit/Provider Information