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

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cms 1500 form 02 12
CMS 1500 Form 02/12

Steve Verno, CMBSI, CMSCS, CEMCS

disclaimer
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

what will not be discussed
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!

what will be discussed
What WILL be discussed!

Changes to the CMS 1500 Form!

When it may be necessary to use a Paper CMS 1500 Form

slide8

0805

0212

slide13
The Court Ordered The Insurance Company to pay an old claim and* The original billing company is out of business
slide35

Valid Condition Codes

W2  Duplicate of original bill

W3  Level 1 appeal

W4  Level 2 appeal

W5  Level 3 appeal

boxes 14 through 33a b are based on the patient encounter visit provider information
Boxes 14 through 33a/b are based on the patient encounter/visit/Provider Information
slide53

(Block 21 using ICD-9-CM Codes)

(Block 21 using ICD-10-CM Codes)

slide69

Enter an X in NO, the check is sent to the patient!

Enter an X in Yes, the insurance company may say

you agree to their UCR payment with no patient billing!

Assignment can be on a claim by claim basis!

questions
Questions?

steveverno@hotmail.com