HCFA-1500 - what is it?

The HCFA-1500 form.  Is this something that gets generated by the EMR, or by the billing program?

Is it printed out and then signed by patient and staff?

Or, is something like this sent by the billing software electonically to somewhere?

Graham-

This is the standardized form used to bill insurance companies in the USA. It is the method that paper filers bill Medicare, PPOs, HMOs, etc. It's usually filled out by the PMS, although there are parts in there (diagnoses, for example) that could be derived from the EMR.

 

Like the above, the HCFA-1500 is the standard professional services billing form.  It is generated by whatever billing system you use including something called a typewriter.

The HCFA-1500 format is required for Medicare billing and by most other payors both commerical and government.  The sister form for outpatient and inpatient services is the UB-92.

 The importance of the HCFA-1500 is that it has to be 'administratively' correct or is subject to denial or rejection by the payors and in most instances by the clearinghouse that you or the PMS is using.  There is an entire business sector dedicated to the care and use by physicians and physician practices of the HCFA-1500.

For example, a missing or 'incorrect' diagnosis will kick back the form and be the basis of a denied claim; the form must be 'signed' etc.  Therefore knowlege of the HCFA-1500 is important to any practice and to practice revenue.

 

 

 

 

Does anyone know of a decent link that shows to fill this form in?

http://www.dol.gov/esa/regs/compliance/owcp/OWCP-1500.pdf

Thanks .. I'll try and read the fine print!

Grahram,

If you're going to do a 1500, then look at this link. Click on Claim Form. This has the requirements for the latest version of the 1500 form, which was approved this summer.

http://www.nucc.org/

Most payer can accept the new form starting in October 2006 and it will be required sometime in 2007. 

Also, the form has been renamed CMS-1500. HCFA-1500 is the old name.

HTH,

Ray

www.symmetryinfo.com 

 

 

Thanks Ray .. I'll look at it.

 BTW, your link is done incorrectly in your signature.
 

Graham,

Thanks for the heads up on the link. I guess I need to put in the http as well.

FYI, a major reason for the revised 1500 form is the new NPI (National Provider Identifier) number. The older 1500 form as well as the UB92 does not account for this number. There is also a newer version of this.

Well let me test the link again <g>.

Here I go,

Ray

http://www.symmetryinfo.com 

 

 

Darn the link didn't work again. I am clicking the "link" on the menu bar.

Do I need to enter some html code or something? Let me try this.

 Please work, please work.

www.symmetryinfo.com

BTW, are you in the US? Billing is a relatively complex thing especially as you move toward ANSI837 (the 1500 in electronic format) and the ANSI 835 (the payment information in electronic format).

Ray 

Nope .. not in USA.

But I will be able to generate the form ... so someone can sign it! 

Graham,

Well if I can answer any questions for you regarding the 1500 or UB92, ask.

Also, fyi, depending on who is filing and who you're filing with, some claims must be filed electronically. 

I just found this Signature area. Let's see if this link thing will work there. Sorry about this, but obviously I'm getting my bearing.

Just a suggestion you may not want to invest a ton of time for signatures as most accounting software programs format for the ANSI 837 format.Many patient accounting software programs create what is called a "print image" and use a batch file to upload to a clearinghouse they are using, mostly via the web.   The fields all relate to a Loop-Segment.  There are some folks who print them, some just for captitated HMO encounter data.  More and more the move is to go electronic and if they are not set up for EDI, then the print images to the clearinghouses is the next and sometimes the best option as the clearinghouse verifies the coding for accuracy.

So, how does the electronic submission capture the signatures of the patient and provider?

Is this deemed no longer necessary for this mode of submission?
 

They have this nice line item #12 for the patient signature "signature on file".  That takes care of the patient.  When you enter the information into the software it has a field to add for this.

For the MD, there's box 25 which is the Federal Tax ID number so they track by either SS# or EIN.  Line 31 prints the signature of the physician.  They all accept this as a signed signature to expedite claims.  There's enough other ways to track back to the MD office along with the new ID number that has been added.  I can see though where you look at the form and usually a blank that says signature, usually requires one, but with ANSI format and in the interest in getting things processed the text is accepted by all.  Who knows why they still call the area "signature'.  That's was why I was advising you not to take too much time on this as almost nobody puts a signature there anymore.  Hope that helps out, strange as it is.