The 1500 Health Insurance Claim Form (1500 Claim Form) answers the needs of many health care payers. It is the basic paper claim form prescribed by many payers for claims submitted by physicians, other providers, and suppliers, and in some cases, for ambulance services.
Read more: New NUCC 1500 Health Insurance Claim Form Reference Instruction Manual V.02/12 - Updated July 2019.
Read more: Tips for Completing the HCFA-1500 (CMS1500) Form
There has been an important update from the Centers for Medicare and Medicaid Services (CMS).
CMS has notified ABILITY that as of April 1, 2019 mainframe eligibility applications hosted in Direct Data Entry/Fiscal Intermediary Standard System (DDE/FISS) and Common Working File (CWF) will be undergoing a process change. Users attempting to verify Part A Medicare eligibility benefits will be required to use a National Provider Identifier (NPI) that is registered in the Medicare Provider Enrollment and Chain/Ownership System (PECOS) database. As part of the eligibility process, these eligibility applications will now verify that the NPI used on the inquiry is present in the Medicare PECOS database.
Read more: New NPI Verification Process through PECOS
Changes to the Medicare Physician Fee Schedule and Quality Payment Program will shift clinicians’ time from completing unnecessary paperwork to providing innovative, high-quality patient care.
Today, the Centers for Medicare & Medicaid Services (CMS) finalized bold proposals that address provider burnout and provide clinicians immediate relief from excessive paperwork tied to outdated billing practices. The final 2019 Physician Fee Schedule (PFS) and the Quality Payment Program (QPP) rule released today also modernizes Medicare payment policies to promote access to virtual care, saving Medicare beneficiaries time and money while improving their access to high-quality services, no matter where they live. It makes changes to ease health information exchange through improved interoperability and updates QPP measures to focus on those that are most meaningful to positive outcomes. Today’s rule also updates some policies under Medicare’s accountable care organization (ACO) program that streamline quality measures to reduce burden and encourage better health outcomes, although broader reforms to Medicare’s ACO program were proposed in a separate rule. This rule is projected to save clinicians $87 million in reduced administrative costs in 2019 and $843 million over the next decade.
Read more: CMS Finalizes Changes to Advance Innovation, Restore Focus on Patients
Starting January 1, 2019, New York workers’ compensation providers may submit original bills using the CMS 1500 form, rather than New York-specific forms C-4, C-4.2, OT/PT-4, PS-4, and C-AMR. Providers nationwide use the CMS 1500 to bill Medicare and group health plans for professional services.
But while the CMS 1500 is a universal billing form, workers’ comp differs significantly from Medicare and group health. The New York Workers’ Compensation Board (WCB) will therefore impose specific requirements for properly completing this form in a workers’ comp context.
Read more: Attention NY Workers Compensation Providers, New HCFA-1500 (CMS 1500) Rules