The HCFA-1500 (CMS-1500) form and instructions are used by non-institutional providers (physician services) and suppliers to bill Medicare, Part B covered services. It is also used for billing some Medicaid covered services. Critical information must be provided in the appropriate fields to avoid delays or denials of submitted claims. Correct patient�s name, address, social security and /or identification number, group number, insurance carrier information, physician information, diagnosis and procedure codes, units of service or supply, date and place of service, hospitalization dates applicable to current service, etc. are essential. Several item 24 fields should be completed carefully, e.g., reference numbers in field 24e link ICD-9 codes listed in field 21 to PCT/HCPCS codes listed in fields 24a and 24d. Only one reference number is entered per line item. The claim is submitted on paper or electronically. Physicians are not required to submit claims for all patients but they do either as a courtesy service or because of contractual agreements with the carriers. Filing also allows payments to made directly to the physician rather than the patient under certain circumstances. It should be noted that many carriers require filing within 45 to 90 days of the date of service.

The physician should collect the applicable co-payment (co-pay) at the time of the visit and, after reimbursement, �balance bill� the patient for the deductible (the amount of money required to be paid by the patient before the carrier begins to cover services) and other possible fees in excess of that allowed by the carrier. Co-pays are automatically deducted from reimbursement amounts paid to the physician.

Contractual agreements with the carriers may limit balance billing to deductibles and prohibit collection of fees for uncovered services or other charges. It is important for the physician to track and trend denials of payment because they indicate problems with coding, claim form completion, accuracy of demographic database, and/or poor verification of patient eligibility. Billing staff should be readily able to generate such reports.

To obtain a electronic copy of Form CMS-1500, CMS-1500 instructions for Medicare, Part B claims and for a copy of Place of Service (POS) codes used on Form CMS-1500, please go to:

www.mtindia.org/freedownloads/default.cfm