Tips for Completing the HCFA-1500 (CMS1500) Form

Table Heading Field Description Data Type Instructions
1 Coverage Optional Show the type of health insurance coverage applicable to this claim by checking the appropriate box (e.g., if a Medicare claim is being filed, check the Medicare box).
1A Insured's ID number Required List the Insured’s identification number here. Verify that the identification number corresponds to the insured listed in item 4. The patient and the insured are not always the same person. Some payers assign unique identification numbers to each enrollee or dependent and require the number of the enrollee or dependent receiving services (the patient) instead of the insured’s number in this item.
2 Patient's Name Required Enter the patient's last name, first name, and middle initial, if any. NOTE: If the patient has a last name suffix (e.g., Jr, Sr) enter it after the last name, but before the first name. Do not use any punctuation in this field.
3 Patient's birth date and gender Required Enter the patient's birth date and sex. Use the eight digit format (MM|DD|CCYY) format for date of birth. Enter an X in the correct box to indicate the sex of the patient. Only one box can be marked. If the gender is unknown, leave blank.
4 Insured Name Required Enter the insured's full last name, first name and middle initial. If the insured has a last name suffix (e.g., Jr, Sr) enter it after the last name, but before the first name.

New NPI Verification Process through PECOS

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

CMS Finalizes Changes to Advance Innovation, Restore Focus on Patients

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

Attention NY Workers Compensation Providers, New HCFA-1500 (CMS 1500) Rules

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

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