What Kind Of Medical Billing Forms Will I Be Using To Get My Clients Paid & How Do I Fill Them Out?
There are many medical billing forms that you as a medical billing service provider will need to prepare, complete and submit in order to either:
Request additional information from your client,
Request additional information on the patient that was seen by your client,
Request additional information from insurance companies, and
A host of other miscellaneous forms that you could create or update for your client.
Instead of boring you to death, lol, I created the medical billing forms webpage to expose you to the most commonly used forms you will be using in your medical billing business to get your clients paid starting with:
CMS 1500 Forms & How To Fill Them Out
CMS 1500 medical billing forms is the standard form that doctors use when they see patients in their office.
This is the form they use to submit the claims to the the insurance carriers in order to get paid for the services they render to their patients.
These forms are red and white in nature, can be generated by your medical billing software when a claim needs to be printed and sent to a carrier by mail, the printed versions can be purchased from many different medical outlets so you have them on hand in your office and they are governed over by the CMS (Centers for Medicare and Medicaid Services).
While revisions to the CMS 1500 Form rarely happens (this new revision goes into effect on 4/1/2014, for more info on what has changed click here), the way it is filled out can differ depending upon which insurance carrier the form is being submitted too.
Needless to say, it is your responsibility as a medical biller and business owner to know which boxes must be filled in for each carrier you submit too in order to avoid the claim form being denied.
When you are not sure I suggest that you contact that insurance carrier and ask them. Yeah it might take some time to get them on the line but at least you’ll know for future reference and you won’t hold up any payments to your clients.
To make my point a little clearer:
Some insurance companies require a authorization number to be listed on the form in box #23 while others carriers do not.
Another example would be if you submit a claim and the what the carrier has on file as the patients birthdate doesn’t match what you entered on the CMS 1500 Form.
As you can see all it takes is a minor mistake to get your claims denied so you have to be focused however regardless of how focused you may be you will receive denied claims, lol.
When you submit claims electronically to insurance companies or clearinghouses they have what is know as scrubbers. What these robots do is scan each and every claim to make sure all the necessary boxes on CMS 1500 Forms are filled out.
While that is great service if you fill out the box incorrectly you will still receive a denied claim but if the robot finds you skipped a box it will tell you so you can correct the claim before it gets submitted.
Correctly completing all the claims you submit (also known as a clean claim) will ensure that your client will be paid in record time and think what they will do for you in return!
All the people I have mentored over the years are expert’s when it comes to filling out medical billing forms because they took the time to learn exactly how it’s done and these are the materials I use to get them to that level:
& as I said before even if you are a perfectionist you will make mistakes so here’s how the pros handle:
OK, now lets move onto…
UB04 Forms & How To Complete Them
CMS 1450 Forms (more commonly known as the UB04 Forms) medical billing forms is the standard form that doctors use when they see and deliver services to their patients in facilities outside of their office such as:
Skilled Nursing Facilities,
Clinics (Inpatient and Outpatient), or
Because these facilities can supply a patient with services that you would not receive in a doctors office such as a wheelchair for example, this form has additional boxes that must be completed with rev codes, hcpcs codes, etc that are not required on the CMS 1500 form.
CMS UB04 forms can be found in black and white or color, can be generated by your medical billing software, the printed versions can be purchased from many different medical outlets so you have them on hand in your office and they are governed over by the CMS (Centers for Medicare and Medicaid Services).
Again, while this medical billing form doesn’t change, the way it is filled out can differ dramatically depending upon which insurance carrier the form is being submitted too and that is why there is a lot of confusion as to how to properly fill them out.
It took me a while before I understood how each situation was supposed to be handled and today I get calls and emails from billers asking me to help them complete the form for their particular circumstance. This is the reason I tell all those I mentor to join a medical billing assoc., org, or forum so when they are confuse they can get the immediate and proper guidance they need.
If at anytime you are in doubt as to what needs to be included or excluded on any claim form please contact the insurance carrier and ask them so you can submit a clean claim and get your client paid the first time around.
To make things even more complicated, you will find that some of your clients may need to bill the insurance carrier using both the UB04 form and 1500 form depending on how your client is credentialed by a particular insurance carrier.
To make my point a little clearer:
If an insurance carrier deems/views my client as being a facility then I would be required to use CMS 1450 Forms to submit a claim (which brings in more money for my clients).
If an insurance carrier deems/views my client as being an office then they would required me to only use the CMS 1500 Forms when I submit claims to them.
Again all it takes is a minor mistake to get your claims denied and with all the other confusing notations that need to be added to these forms you must be alert to what you inputting on each and every claim.
To make sure you become an expert’s when it comes to filling out CMS 1450 Forms here are 2 resources I use to train my students and those I mentor:
& this is how you’ll deal with the denials and appeals once the need should arise (and it will, lol, I can promise you that):
OK, now lets move onto…
C4 Forms & How To Fill Them Out
Unlike the two medical billing forms above submitting C4 Forms and C4.2 Forms (also known as the Doctor’s Initial Report) is less of a hassle because they are pretty straight forward.
These forms are used when your client treats a patient that sustains an injury while at work and is commonly referred to as Workman Compensation Claims.
C4 forms are required to be filed within 15 days of the date the patient was first seen by your client.
Once the initial form is submitted all addition visits must be billed within 45 days and include all reports concerning ongoing treatments as well as a final report once the course of treatment is complete.
As I stated both C4 and C4.2 Medical Billing Forms are pretty simple however, if you exclude any information it will negatively impact the outcome of a hearing and in turn the monetary award of the claim.
Here are some of the commonly made mistakes that are made on most Workman’s Compensations Forms:
The correct identification of the claimant or claim,
The claims POF (parties of interest) info,
The claimants complete injury history which must include:
The correct diagnosis,
The disability status,
The course of treatment prescribed by your client,
The nature of the accident as it relates to said disability, and lastly
The degree of the claimants impairment.
Depending on the type of medical billing software you use these medical billing forms might already be included so all you need to do is fill it out, print it out for the doctors signature and submit it as directed.
If it is not included in your medical billing software you can download a blank form online through your state’s workman’s compensation website, type in the requested information, print it out for your client to sign and then submit it that way.
Unlike the other claims forms we have discussed that are submitted directly to an insurance carries or clearinghouse the C4 Forms and C4.2 Forms have to be submitted directly to both of the following:
The workers’ compensation insurance carrier, and
The state workers’ compensation board.
All the information you provide will be scanned into a database and will be used when or if the case goes to a hearing so it is crucial for you to provide what’s need to move the case forward to ultimately get your client paid the maximum allowed.
Since people frequently get hurt while on the job I have all my students and those I mentor take a short and inexpensive online course to make sure they understand the process in it’s totality so they get their clients paid the first time around. Here is the course I endorse (once the page loads, scroll down the page and click on the Workers Compensation link):
CMS 855I Medicare Enrollment Forms & How To Complete Them
The CMS 855I Medical Billing Forms are usually filled out by your client when they decide that they would like to treat patients that are insured through Medicare. No doctor can just submit a claim and expect to get paid for the services they provided without them first being enrolled to do so.
The problem for doctors is that the forms are lengthy, sometimes complicated and are a pain in the butt to complete, lol, so most of them decline seeing Medicare patients. While being enrolled will not bring the practice a lot of money it does allow your clients to expand the different types of patients they see.
What I tell all those I mentor is you as a medical billing service is:
Completing The 855I Forms For Your Clients Is An Additional Revenue Stream For Your Business And You Can Get Paid Handsomely For Doing So Since Doctors Dread The Process!
In addition, you could use completing these medical billing forms as a marketing ploy to get your foot in the door of potential clients! Sneaky? Yeah I know, lol, but it works and I have used this technique on:
Anesthesiologists and Anesthesiology Assistants
CNS’s (Clinical Nurse Specialists)
CPM’s (Certified Professional Midwife)
LCP’s (Licensed Clinical Psychologists)
LCSW’s (Licensed Certified Social Worker)
MD’s (Private Practitioners)
NP’s (Nurse Practitioners)
OT’s (Occupational Therapists)
PA’s (Physician Assistants)
PT’s (Physical Therapists)
RD’s (Registered Dietitians)
RN’s (Registered Nurses)
SLP’s (Speech-Language Pathologists)
If you are billing for a service provider that is not mentioned above make sure you contact your designated fee-for-service contractor before submitting the application.
If your client also performs diagnostic testing then they may be required to complete and submit all CMS-855B medical billing forms and enroll as an Independent Diagnostic Testing Facility (IDTF). This is especially true when substantial portions of your clients diagnostic testing (other than clinical laboratory or pathology) is provided to patients that are not their actual patients. If your client falls in this category make sure you check with a Medicare fee-for-service representative to determine if you need to enroll as an IDTF or not.
Here is the resource I use to train my students to make them experts at filling out the 855I Forms need to get their clients approved to accept Medicare patients the first time around:
For the most updated and detailed information about the proper way to setup, start and operate a successful home based billing business immediately download my ebook entitled “The Medical Billing Home Business Bible” you can’t miss it, it’s located in the column to your right, close to the top
I really enjoyed sharing with you today and I hope you learned about the main types of medical billing forms you will be using in the daily operations of your home based medical billing business and how to correctly fill them out.
Here Is To Your Success,
“The Medical Billing, Coding & Transcription Mastermind”
P.S.: Don’t forget to hover your mouse over the “Medical Billing Tips” tab under the logo a the top of the page for more advice.
External Medical Billing Forms & How To Fill Them Out Resources: