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Joy Hicks

This Week's Q & A

By April 18, 2011

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Question: What is the CMS-1500 form used for?

Answer: The CMS-1500 is the red-ink on white paper standard claim form used by physicians and suppliers for claim billing. Although it was developed by The Centers for Medicare and Medicaid (CMS), it has become the standard form used by all insurance carriers.

Any non-institutional provider and supplier can use the CMS-1500 for billing medical claims.

  • Physician services
  • Physician assistants
  • Nurse practitioners
  • Clinical nurse specialists
  • Nurse midwives
  • Certified registered nurse anaesthetists (CRNA's)
  • Clinical psychologists
  • Clinical social workers
  • Home dialysis supplies and equipment
  • Ambulance services
  • Clinical diagnostic laboratory services

When preparing the CMS-1500, use the following as a guide:

  1. Ensure that all data is entered correctly and accurately in the correct fields.
  2. Enter insurance information including the patient's name exactly as it appears on the insurance card.
  3. Use correct diagnosis codes (ICD-9) and procedure codes (CPT/HCPCS) using modifiers when required.
  4. Use only the physical address for the service facility location field.
  5. Don't forget to include NPI information where indicated.

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