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Step-by-Step for Completing CMS 1500

CMS 1500, also called a HCFA 1500, is an insurance form submitted by the provider to the insurance company for payment of services rendered to a patient. Most of the larger medical offices file insurance claims electronically and receive payment through electronic funds transfer, whereas in a small medical office, insurance claims are filed on paper by submitting the CMS 1500 for payment of services. This form contains basic personal and insurance information about the patient, along with the appropriate diagnosis and treatments for the physician encounter being billed. The administrative medical assistant is usually the one responsible for filling out the CMS 1500 in order to solicit payment for services from the insurance company.

The first 2 things which you would need.

  • Insurance card
  • CMS 1500 form     
  1. Insert the name and address of the insurance company in the upper right-hand corner of the form. The insurance company address is referenced on the form to let the medical billing agent know where to submit the insurance claim.  
  2. Fill in boxes one through 13 of the upper section with personal and insurance information from the patient registration sheet. Box 1 is where you would check the type of insurance and 1a is for the insurance group identification number. Boxes 2 through 8 are self-explanatory. Box 9 is for the primary insurance information of the patient. Check all boxes applicable in Box 10 as related to the current injury or condition. Box 11 is for secondary insurance information. Boxes 12 and 13 are for the patient, guardian and/or insured's signature.
  3. Fill out the bottom section of the CMS 1500 form with pertinent information regarding the physician encounter for which you are billing the insurance company. Box 14 is where you would enter the date for the physician encounter. Enter a date into this space if the patient has had the same or similar illness. Box 16 is where you would enter the dates the patient was unable to work due to the injury or illness. Fill in the dates in boxes 15 and 16, if applicable.  
  4. Enter the name of the physician who saw the patient on the date being billed in Box 17 and their National Provider Identification (NPI) number in 17b. Enter dates of hospitalization, if necessary, in Box 18. Box 19 is left blank.
  5. Check Box 20 if the patient has received outside lab tests or blood work. Box 21 is for the diagnosis. The diagnosis code can be found on the patient encounter form and is needed by the insurance company to show the medical necessity for the procedures or treatments being billed. The physician will fill in the diagnosis code at the end of the visit, after he or she has evaluated the patient. Diagnosis codes are found in the International Classification of Diseases, 9th Edition (ICD-9), now that ICD-10 is out you can refer that also, by looking up the condition in the alphabetical section. Once the code has been found in the alphabetical section, it has to be double-checked in the numerical tabular section to verify the proper diagnosis code has been referenced. There are spaces on the CMS 1500 form for up to four diagnoses.  
  6. Enter a Medicaid Resubmission Code or reference number in Box 22. Box 23 is where you would enter a prior authorization number if prior authorization was required for the procedure being billed.
  7. Enter specific encounter information in Box 24. The date is entered in 24A. The place of service code is entered. A place of service code is found in the front of the Current Procedural Terminology, 4th edition (CPT-4). Box 24C is used for an emergency code. Box 24D is for the procedure code and modifiers from the CPT or HCPCS coding books. The medical office assistant will fill in these codes according to the services which were provided by the physician during the visit. In Box 24E, enter a diagnosis pointer. The diagnosis pointer refers to the diagnosis from Box 21 to which the procedure was related. Box 24F is for the charge of the procedure performed. Fill in Boxes 24G, H, I and J with unit, EPSDT Plan, medicinal codes and the rendering or national provider identification number, whichever is required for that specific insurance company. Procedures must be written one per line in Section 24. If the form is not properly filled out, the insurance company can deny the claim, leaving it unpaid.  
  8. Enter the physician's federal tax ID number in Box 25, the patient's account number in 26 and check the box that says "accept assignment" in Box 27. Box 28 is for the total charges. Fill in the amount paid, if any, in Box 29 and the balance due in Box 30. Box 31 is for the physician's signature. In Box 32, fill in the facility name and address where the services were performed. Finally, in Box 33, fill in the name, address and contact information for the billing provider, along with their NPI or Medicare provider number.

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