CMS 1500 Claim Form

It is important to follow payer guidelines when completing a claim form; otherwise, reimbursement will be delayed until the form is corrected.

Other patient information you may find is documentation for any allergies the patient may have. Insurance information will be noted if the patient is covered were you will find the provider, the billing address, and the patient’s policy number. There will be many different forms in this system that are used to document things such as the patient’s family history, diagnostic results, immunization records, past and present medications taken and the effectiveness of them, and of course there will be doctors notes for any office visits and hospitalizations. In the doctors notes and hospitalization notes you will find documentation for medical conditions or diseases the patient may have had in the past or has presently. Last but certainly not least there will be the common release and authorization forms, there may be advanced directives or living wills on file if the patient has completed them and other relevant information that staff and medical facilities may need to provide quality care for the patient. (Whatis.com, 2008).

The information that should be obtained from the patient at the time of scheduling the appointment is the reason for the visit, name, DOB, phone number, and insurance information.

Responsible coder collects post and manages account payments, submitting claims and keeping in touch with insurance companies. If patient information is coded incorrectly or incomplete it could leave an impact that can be brought to a claim. Inaccuracy in patient information can leads to denials, none payment and investigation. It is important to get all the details right by verifying insurance coverage properly. Make sure that the patient’s name is spelled correctly, date of birth and sex of patient are correct; and most important be sure that the policy number is valid.0verall before claims are sent, documentation should be in order and the claim should be checked for completeness and accuracy.

H. (04/2015). Comprehensive Health Insurance: Billing, Coding & Reimbursement, VitalSource for Allen School of Health Sciences, 1st Edition. [Bookshelf Online]. Retrieved from https://online.vitalsource.com/#/books/9781323131503/

Step 5 - Transmitting of Claim - Once the patient has been seen my physician you will look oh the ERH and see what the patient was diagnosed with along with the claim that was prior prepared. This will be submitted to the insurance company awaiting payment.

Appointment/Registration - This determines whether an individual is an established or new patient; if the patient is new, then insurance information is obtained and verified to make sure that the patient qualifies to receive services from the provider.

The first area outlined in the intake form is the client’s demographic information that included the client’s date of birth, social, insurance information, etc. necessary to process claims for reimbursement and the client’s provider information, such as primary care, and case management, to ensure fluidity for establishment of coordination of care between providers. The intake form

|  Re-imbursement for the insurance. If the paper work is not right it will affect billing and can create major problems.

NOTE: Effective April 1, 2014 Medical Assistance (MA) will only accept the revised CMS-1500 form (02-12) version

The value of CDI clinical documentation improvement (CDI) programs are important to any facility that recognizes the requirement of complete and accurate patient documentation. Documentation is very critical because it validates the care that was given. Furthermore, it shares important data to the caregiver and improve claims processing (Leventhal,2014). The three challenges are getting physicians to buy into the program, physicians are extremely busy so they are not connecting the dots on clinical documentation, and training the physicians to get them to understand they need to do better documenting (Leventhal,2014).

The medical forms on this page authorize our pediatricians to provide care and allow our pediatric office to maintain up-to-date records.

Hair is expected to submit medical document for her and her child by 02/2017. Ms. Hair failed to submit updated medical documentation. Case Manager reminded Ms. Hair if she failed to submit the document required on her next meeting it would be considered non-compliance and a warning for non-compliance will be issued. Ms. Hair stated that she was aware.

Patient fills out and signs new patient registration forms. Copies of I.D. and insurance cards are made.Create encounter form and new patient chart.

Responsible coder collects post and manages account payments, submitting claims and keeping in touch with insurance companies. If patient information is coded incorrectly, or incomplete it could leave an impact that can be brought to a claim. Inaccuracy in patient information can lead to denials, none payment and investigation. It is important to get all the details right by verifying insurance coverage properly. Make sure that the patient’s name is spelled correctly, date of birth and sex of the patient are correct; and most important be sure that the policy number is valid.0verall before claims are sent, documentation should be in order and the claim should be checked for completeness and accuracy.