Week 3 Introduction: Practice makes perfect. This week you have the opportunity to practice system one of the most common forms in medical billing, the CMS 1500 form for submission to a variety of insurance payers. You will learn the revenue implication of submitting a “clean” claim and the impact on your current or future employer . Week 3 Objectives: Compare and contrast medical insurance payers and Complete CMS-1500 form.
Required Resource:
ISBN: 978-0-07-351371-3
Valerius, J., Bayes, N., Newby, C., Blowchowiak, A. (2012). Medical Insurance, an Integrated Claims Process Approach. (6th Ed.), New York, NY: McGraw-Hill Publishers.
- Chapter 7
- Chapter 8
- Chapter 9
- Chapter 10
- Chapter 11
- Chapter 12
ISBN: 978-0-7637-5964-3
Valerius, J., Bayes, N., Newby, C., Blowchowiak, A. (2012). Medical Insurance Workbook. New York, NY: McGraw-Hill Publishers.
Weblinks:
- CMS 1500 Form:
http://highered.mcgraw-hill.com/sites/0073513717/student_view0/cms_1500_and_ub-04_forms.html#
Written Assignment – CMS-1500
Lead in:
The CMS-1500 is a paper claim for physician services that is accepted by most payers. Reimbursement professionals working in physician practices need to develop proficiency in completing the CMS-1500. This will give you an opportunity to practice this skill which will make you an asset to any future employer.
To prepare for this assignment:
- Read Chapter 7 in the Medical Insurance, an Integrated Claims Process Approach
- Download the CMS-1500 form:
http://highered.mheducation.com/sites/0073513717/student_view0/cms_1500_and_ub-04_forms.html#
With this in mind,
Using the Interactive CMS-1500 Form, complete the following:
- Five (5) BC/BS
- Five (5) Medicare
- Five (5) Medicaid
- Two (2) Tricare
- Two (2) Workman’s Comp
Use ideas from the class text and your own experiences to create “make believe” scenarios and complete the claims bulleted above. Be sure to provide a very brief scenario with each claim (i.e. patient broke arm and had surgery); a different scenario should be used for each claim. Data can be input and saved as a .pdf in the link provided.
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