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Ancillary Services, Coursework Example

Pages: 3

Words: 771

Coursework

Production of Word Document

Instructions on how 1500 CMS form should be filled out

Step. 1- This form is best filled out in blocks beginning with the first section where the patient’s insurance provider must be clearly identified. In the opening block there is written Medicare/Medicaid/ Campus etc. In this block carefully tick, which insurance the patient is eligible for.

Step.11. Now correctly copy the patient’s personal data from the section of his/ her chart carefully onto the form. Double check to make sure that there are no errors to be corrected, such as name; social security number; address or age.

Step. 111. Box 4 needs special attention. It is important to double check this section because some patients have more than one insurance, which may be a family plan. Therefore, Medicare would need to have this information in order to correctly bill the client.

Step. 1V. Note section 9 carefully. This section should only be filled out unless the patient has consented towards assigning their Medicap to the institution which rendered care during his/her illness.

Step. V.  Section 10. Fill out the boxes to indicate whether the incident was related to employment or an accident.

Step. V1. Section 11. This is an attempt to have the patient correctly establish which insurance coverage is applied to the particular incident. Therefore, it must be distinctly  marked Medicare/Medicaid or another private insurance.

Step V11. It is important to note that from section 12 – 13 is marked reserved for billing authorities. Therefore, it must be filled out properly by the billing specialist to ensure that the patient is not overcharged for services neither service providers are under paid. As such, the date when symptoms of the illness began must be noted; while 14 and 15 requires that a record of whether the patient was previously treated for that illness at the institution must be given.

Step. V111.Sections 16 – 24  is where precise information regarding the illness and how the patient was attended must be carefully documented in order for the participating physician be appropriately remunerated as well services billed for the institution to retrieve payments. Hence, Physicians’ names, services, dates of services, procedures, and cost must be accounted for in detail. 

Step. 1 X .Precise billing of Ancillary services for a patient with COPD, now begins. In Box 21 the code for COPD must be entered. According to the International Center of Disease (ICD) coding guide a total of four codes can be entered in cases of uncertainty or if the patient has a number of diagnoses besides the one being treated at the time.

Step. X. Boxes 22 and 23 are completed if the patient is a Medicaid recipient and a pre-authorization number is filled into 23 if the patient provided one to the institution

Step X1. Section 24 asks for the procedural codes, which have been provided by the American Medical Association for billing purposes. Pay close attention in differentiating services which are coded ancillary as against nursing when accounting for ancillary charges distinctly.

Step X11  Finally, Remember to enter the Physician’s Tax ID number in box 25, patient’s account number in 26, insurance company number; ‘yes ‘ ticked for 27 and 28 -30 a display of charges based on CPT codes. Boxes 31- 33 require that the physicians’ signature be on the form, the facility’s address and the place where  billing information is to be tendered.

Possible mistakes that can occur

Mistakes which are common in filling out 1500 CMC forms are two fold. They can occur as filling out wrong personal data for patient or physician and coding issues. The most common are coding issues which auditors  call coding errors.

Personal Patient/ Physician information errors include incorrect insurance numbers; insurance companies and dates services were rendered. This is why it is important to cross check these information before the patient leaves the facility to make sure that all the information is accurate.

The billing specialist must be acquainted with the specific codes for each procedure service the patient/ client obtains during his/her stay either at the emergency or ward of the facility. There are 10 coding errors which must be avoided at all times.

These are unbunding codes, miscoding diagnoses; misinterpreting and misunderstanding doctor’s reports and orders; physicians not recording services on the required forms; coder and biller limitation pertaining to actual benefits of the insured; collecting co-pay upfront; under coding; insufficient information about the provider; coders do not have contemporary knowledge concerning changes occurring in the science and physicians incorrectly recording services.

References

Health Insurance Claim Form (2012) 1500 CMC claim Form sample Pdf. Retrieved 3rd March, 2012 from http://www.cms.hhs.gov/cmsforms/downloads/CMS1500805.pdf

Medical Billing and Coding blog (2012) 10 Most Common Coding Mistakes. Retrieved 3rd March, 2012 from http://mbc.blog.ultimatemedical.edu/2010/04/the-10-most-common-coding-mistakes/

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