A claim must be generated in order to report patient services to a third party Payor’s within the guidelines of the negotiated contract and/or governmental compliance guidelines in order to receive reimbursement for the services rendered. The bill forms are designed by National Billing Committee and all claim must be reported on this defined platform universally.
Medical Billing is a complex process and has a direct effect on the bottom line and financial performance. For most Healthcare providers RCM includes everything from Pre-registering a patient all way through the final zero balance invoicing for a visit.
Our experienced Billers goal is to submit the bills to the payers within 48 hours from the date of service. They will verify insurance eligibility, confirm the correct insurance company, and ensure that all the necessary documentations are submitted along with the charts right at the first time to the Payers so that the bills get paid on time.
- Two type claim form used
- CMS 1500 (HCFA -1500)
- CMS 1450 (HCFA -1450 or UB-04)
- The Center for Medicare and Medicaid Services form (HCFA-1500) is a standardized billing form
- CMS 1500 (HCFA -1500)
- CMS 1450 (HCFA -1450 or UB-04)
CMS 1500 also contains information (i.e., patient name, date of service, service code, etc) needed by the most of the payers in order to adjudicate a large majority f their claims.
The uniform bill known as the CMS 1450 (UB- 04) is used by hospitals, skilled nursing facilities and home health agencies to bill all insurance carriers. The CMS 1450 is used to bill inpatient and outpatient services provided to patients. This form is used to bill the technical component of services as well as facility charges such as food, room, pharmacy drugs, and medical equipment.
The purpose of the form is to standardize the data submitted to carriers for reimbursement. However, reporting requirements and format vary from payor to payor. Some fields are mandatory where others are optional. There are 81 locators in an CMS 1450.
The values and entries entered on a CMS 1450 paper claim form can also be submitted electronically. Medicare encourages the submission of claims electronically, instead of submitting paper claims, whenever feasible.
As per new HIPAA regulations providers are mandated to sent the form electronically to comply with compliance.
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