Completing the CMS 1500 Form: New Changes

Transcription

1 Completing the CMS 1500 Form: New Changes Presented by: John Florence Part B Provider Outreach and Education Cahaba GBA February 18,

2 Housekeeping Tips When you called in, did you enter your attendee code? Dial-in number: Attendee (participant) Code: The audio portion of the conference may be accessed via the telephone or by using your computer's speakers. The preferred method of listening is via the toll-free number Ensure the address provided during registration is correct and make sure that your SPAM filter is turned off for items coming from 2

3 To Access Materials from this Presentation.. During the presentation, go to our Calendar of Events page and click on The Title of the Event and look under Instructions/Materials PowerPoint Presentation Handout After the presentation, PowerPoint and the recording of event will be made available on our Cahaba University webpage /recorded-events/ events/ 3

4 Disclaimer This information released is the property of Cahaba GBA and CMS. It may be freely distributed in its entirety but may not be modified, d sold for profit or used in commercial documents. While all information in this document is believed to be correct at the time of creation, this document is for educational purposes only and does not purport to provide legal advice. 4

5 Agenda History of CMS 1500 From Methods of Claim Submission Advantages of Filing Electronically Timely Filing Limit Overview of CMS 1500 Form Difference between 08/05 & the 02/12 version Step-by-Step Instructions Paper vs. Electronic Self-Service S Tools Website Resources 5

6 Methods of Claim Submission Claim filing requirements Paper Claim format 29 days on payment floor Electronic Media Claim (EMC) format 14 days on payment floor Time limitations on claim submissions Dates of Service: January 1, 2010 and after Within one calendar year from date of service 6

7 Mandatory Claim Submission-Exceptions Administrative Simplification Compliance Act (ASCA) Prohibits payment of services that a provider did not bill to Medicare electronically. Exceptions: Small providers with fewer than 10 full-time equivalents; Roster billing of mass immunizations; Demonstration projects that requires claims to be submitted on paper; MSP claims with more than one primary payer; Dental claims; Services furnished edousdeo outside of the eus; U.S.; Disruption in electricity of communication; and Providers that submit few than 10 claims per month on average. 7

8 History of the CMS-1500 Form Formerly known as HCFA 1500 CMS-1500 Form modified to include split provider identifier fields to accommodate National Provider Identifier (NPI) Implemented January 1, 2007 New Form revision number 08/05 Effective April 1, 2014, any paper claim, including resubmissions i or corrections, must be submitted on the 02/12 version of the CMS-1500 Note: Any claim submitted on the previous version (08/05) will be returned as unprocessable. 8

9 CMS 1500 Update 9

10 CMS 1500 Breakdown: 02/12 Version Patient Demographic Information Information about Patient s visit to Doctor/Physician Information about Doctor/Physician 10

11 Tips on Completing 1500 Form -The Font Should Be: Legible In black ink Courier or Arial in 10, 11, or 12 point font Capital letters -The Font Must Have: Dot matrix print Bold, script, italic or stylized font Broken characters Red ink 11

12 CMS 1500 Form Quick Reference Chart Abbreviation Description MM Month of the Year (e.g., September = 09) DD Day of the Week (e.g., Sept 15 = 15) YY 2 position Calendar Year (e.g., 2014 = 14) CCYY 4 position Calendar Year (e.g., 2014 = 2014) (MM DD YY) or (MM DD CCYY) (MMDDYY) or (MMDDCCYY) A space must be reported between month, day, and year (e.g., or ). This space is delineated by the dotted vertical line on the CMS-1500 Form No space must be reported between month, day, and year (e.g., or ). The date must be recorded as one continuous number. 12

13 VS. CHANGES TO THE CMS-1500 FORM (Sections) Version 02/12 13

14 Header Old: New: 1 2 Replaced 1500 rectangular symbol with black and white two-dimensional QR Code (Quick Response Code) Changed 08/05 to 02/12 14

15 Footer- 08/05 version Not sure if you are using the correct form? The bottom right corner should say

16 Footer- 02/12 version Not sure if you are using the correct form? The bottom right corner should say

17 Item 1 Paper: Electronic: Old: x New: Loop Segment Description 2000B SBR09 Medicare Indicator = MB x Changed TRICARE CHAMPUS to TRICARE Replaced SSN with ID# 17

18 Item 8 Old: New: Paper: x x Electronic: Loop Segment Description Not Mapped Not Mapped Not Mapped Deleted PATIENT STATUS and content of field Changed title to RESERVED FOR NUCC USE 18

19 Item 9B Paper: Electronic: Old: Loop Segment Description x Not Mapped Not Mapped Not Mapped New: Deleted OTHER INSURED S DATE OF BIRTH, SEX Changed title to RESERVED FOR NUCC USE 19

20 Item 9C Paper: Electronic: Old: Loop Segment Description Not Mapped Not Mapped Not Mapped New: Deleted EMPLOYER S NAME OR SCHOOL Changed title to RESERVED FOR NUCC USE 20

21 Item 10D Paper: Electronic: Old: Loop Segment Description 2300 HI Other Condition Codes New: Changed title from RESERVED FOR LOCAL USE to CLAIM CODES (Designated by NUCC) 21

22 Item 11B Paper: Electronic: Old: Loop Segment Description Local Company 2010BA REF01 REF02 Other Claim ID New: Deleted EMPLOYER S NAME OR SCHOOL. Changed title to OTHER CLAIM ID (Designated by NUCC) Added dotted line in the left-hand side of the field to accommodate a 2-byte qualifier 22

23 Item 14 Old: Paper: Electronic: Loop Segment Description New: DTP01 DTP = Accident Date 431 = Onset of Current Illness or Injury 454 = Initial Treatment Date Changed title to DATE OF CURRENT ILLNESS, INJURY, or PREGNANCY (LMP) Removed the arrow and text in the right-hand side of the field Added QUAL. with a dotted line to accommodate a 3-byte qualifier 23

24 Item 15 Paper: Electronic: Old: Loop Segment DTP01 DTP03 New: Changed title from IF PATIENT HAS HAD SAME OR SIMILAR ILLNESS. GIVE FIRST DATE to OTHER DATE Added QUAL. with two dotted lines to accommodate a 3-byte qualifier 24

25 Item 17 Old: Paper: Electronic: Loop Segment Description New: John P Doe 2310A (Referring) 2310D (Supervising) 2420E (Ordering) NM101 NM103 NM104 NM105 NM107 DN, DK, DQ= Provider Last Name Provider First Name Provider Middle Name DN John P Doe Added a dotted line in the left-hand side of the field to accommodate a 2-byte qualifier DN- Referring Provider DK- Ordering Provider DQ- Supervising i Provider 25

26 Item 19 Old: Reserved for Local Use Electronic: Loop Segment 2300 NTE PWK New: Additional Claim information Changed title from RESERVED FOR LOCAL USE to ADDITIONAL CLAIM INFORMATION (Designated by NUCC) 26

27 Item 21 Old: Paper: DX 1 DX 3 DX 2 DX 4 New: 9 or 0 DX 1 DX 2 DX 3 DX 4 DX 5 DX 6 DX 7 DX 8 DX9 DX10 DX11 DX12 Electronic: Loop Segment Description HI01-02 BK = Principal 2300 Diagnosis Code HI02-02 thru Added ICD Ind. and two dotted lines Added 8 additional lines for diagnosis codes Changed labels of the diagnosis code lines to alpha characters (A L) Removed the period within the diagnosis code lines BF = Diagnosis Code 27

28 Item 22 Old: Paper: Electronic: Loop Segment Description New: 2300 CLM05-3 Claim Frequency Code 2300 REF02 Payer Claim Control Number Changed title from MEDICAID RESUBMISSION to RESUBMISSION 28

29 Item 24E Old: Paper: Electronic: Loop Segment Description SV st Diagnosis Code Pointer 2400 New: SV nd Diagnosis Code Pointer A B C SV107-3 SV rd Diagnosis Code Pointer 4 th Diagnosis Code Pointer Enter the diagnosis code reference letter as shown in Item 21 to relate the date of service and the procedures performed to the primary diagnosis 29

30 Item 30 Old: Paper: Electronic: Loop Leave Blank Segment Not Used by Medicare New: Deleted BALANCE DUE. Changed title to Rsvd for NUCC Use 30

31 Paper Claim Mailing Addresses All paper p claims must be submitted to: Alabama Georgia Tennessee Medicare Part B Claims Medicare Part B Claims Medicare Part B Claims PO Box Birmingham, AL PO Box Birmingham, AL PO Box Birmingham, AL

32 ICD-10 Implementation CMS will be sponsoring the classes Available for online and in-person They will offer more than 50 classes March, April and May Classes include specialty references 32

33 Transitioning to Jurisdiction J CMS awarded Jurisdiction J (JJ) A/B Medicare Administrative Contractor on September 17, 2014 Transitioning from J10 to JJ Administration of Medicare Part A and Part B Alabama, Georgia and Tennessee Part B workload will assume full responsibility on July 1, 2015 Watch the Cahaba GBA website for communication throughout the implementation and transition 33

34 InSite Recertification Cahaba GBA will be conducting mandatory recertification for InSite Local Security Officers and users Recertification period is scheduled for February 15 through April 15, 2015 All MACs are required by the Centers for Medicare and Medicaid Services 34

35 Self-Service Tools- CMS 1500 Form Interactive CMS-1500 Form /07/interactive-cms-1500-form.pdf EDI 1500 Crosswalk /02/edi-1500-crosswalk-2.pdf 35

36 CMS 1500 Form Resources Pub 100-4, Chapter 26 of the CMS Online Manual System Guidance/Guidance/Manuals/downloads/clm104c26.pdf National Uniform Claim Committee (NUCC) Form CMS-1500 At A Glance _fact_sheet.pdf Ordering the CMS-1500 Claim Form medicare-part-b-ordering-cms-1500-claim-forms/ d i i 36

37 Medical Billing and Coding Resources American Academy for Professional Coders (AAPC) American Medical Billing Association (AMBA) American Health Information Management Association (AHIMA) Centers for Medicare and Medicaid id Services (CMS) 37

38 Question and Answer Session 38

39 Evaluate Your Experience with Today s Educational Event To ensure that the Provider Outreach and Education department continues to be responsive to your needs, we are providing you with the opportunity to evaluate today s event. To complete the evaluation, access the following link: C82874E 39