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Cmms-1500 Research Paper

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Discuss the type of information included on the different claim forms.
Claim forms are used to submit services and procedures provided to patients from providers for reimbursement purposes. For example, auto accidents require an explanation of benefits attachment or if the claim is for durable medical equipment, medical necessity must be proven which can be done with a letter from the physician and a copy of the prescription. The CMS-1500 form has areas known as form locators which state what should be completed on the form such as demographics, diagnosis and procedure codes, modifiers, and more.
Compare and contrast the information for the CMS-1500 and the UB-04.
The CMS-1500 form is used by physicians and suppliers which is known as professional billing while the UB-04 is used by hospitals, nursing facilities, hospice and is known as institutional billing. Each has an electronic format that can be used with the last letter indicating whether it is institutional or professional. The UB-04 form is a summary and is accompanied with an itemized bill. The UB-04 form has 4 sections and eighty-one form locators. The CMS-1500 form is divided into two sections, completion guidelines vary on state and local levels which means the office specialist will have to check the rules for certain carriers. …show more content…
A lack of accuracy may result in a rejected or delayed claim. Some reasons for denied or delayed claims are: submission to the wrong carrier such as sending the claim to the secondary carrier instead of the primary carrier, incorrect or transposed numbers, lack of signature, not coding to the highest level of specificity, incorrect use of modifiers, and missing information. These are just a few reasons claims may be denied or delayed. These type of mistakes can cause cash flow problems for the facility therefore it’s imperative that all information be verified and audited for accuracy before

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