CMS Claim Form PAGE \* MERGEFORMAT 4
CMS Claim FormGeneration and SubmissionMedical Administration PrinciplesDonna CorcoranCMS Claim FormGeneration and SubmissionThe CMS-1500 claim form, (formerly called the HCFA-1500) was originally implemented by the Healthcare Financing Administration (HCFA), now called Centers for Medicaid and Medicare Services.This form must be used when submitting claims to Medicare and Medicaid. The Centers for Medicare & Medicaid Services (CMS), formerly the Health Care Financing Administration (HCFA), was created in 1977 (answers.com) to combine the synchronization of Medicare and Medicaid. The CMS uses a small part of the US budget to manage the two programs, which insure millions of Americans.To generate a CMS-1500 claim form, the billing specialist must collect detailed information from not only the patient, but also the physician. Information needed to complete a CMS-1500 form is as includes all information regarding the patient.
Patients Name (Last, First, Middle Initial)
Home Address and Phone Number
Employer, Address and Phone Number
Date of Birth
Social Security Number
Referring Providers Name
Spouse's Name, Occupation, and Place of Employment
Emergency Contact Information
Health Insurance Information
(Understanding Health Insurance, pg. 60)The billing specialist also must collect information from the physician, regarding, diagnoses and treatment. Proper codes must be assigned and entered in the proper blocks on the insurance form. The CMS-1500 form must include all charges and total charges billed. Correct modifiers must be used when detailing an office visit, ER visit, etc. You must be sure the form has been signed, or "SOF" (signature on file) is input, the referring physician information is entered, and the EIN and provider numbers are also entered.Most of this information can be obtained from the encounter form, but sometimes it may be incorrect or missing. It is important to have all of the information required for the CMS-1500 form. The next step would be to submit the form for paymentClaim forms can be submitted manually or electronically. "A claims submission is the transmission of claims data (electronic or manual) to payers or clearinghouses for...