Unit 1 Assignment Essay

289 WordsSep 7, 20152 Pages
UNIT 1 ASSIGNMENT Healthcare physicians, such as a family doctor or clinic, use the CMS-1500 health insurance claim form by submitting a paper billing document for the procedure or service provided to patients; if this is not documented the claim will be denied (Gail I. Smith, 2015). The UB-04, also known as CMS-1450 claim form, is used primarily by hospitals for both outpatient and inpatient services, third-party payers to report claims for outpatient and inpatient services provided by hospitals, and ambulatory surgery centers (Gail I. Smith, 2015). These two forms are different because of the location of services provided and what committee is responsible for creating and updating the two forms. The National Uniform Claim Committee is responsible for updating the CM-1500 Health Insurance Claim Form, which is used for services provided for patients by physicians. The National Uniform Billing Committee is responsible for the UB-04, which is used by hospitals, inpatient or outpatient, or ambulatory surgery centers for services provided to patients. The CMS-1500 and UB-04 claim forms required the same types of information which include: patient, payer, 2nd payer, and addresses; patient and providers I.D. numbers, type of insurance plan the patient is covered under, name of patient, date of birth, diagnosis codes, place of service codes, date of service, and service provider information. If information is entered incomplete or incorrect, the claim would be denied. Thus, the claim would have to be resubmitted. After it is resubmitted, the form has to go through an appeal process which can slow down the claim process for reimbursement. References Gail I. Smith, M. R.-P. (2015). Basic Current Procedural Terminology and HCPCS Coding. Chicago: American Health Information Management

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