Webinar
November 30, 2005
Topic: Completion of the CMS-1500 Claim Form
Questions & Answers
Question 1: If
we are a surgical center do we need to put the PIN in Item 24k?
Answer 1: Ambulatory Surgical Centers do not need to complete Item
24k.
Question 2: Can
the address not matching up to attending doctor information cause a MA130
denial?
Answer 2: Yes, this would cause a claim to reject.
Question 3: Item 24e, if there is multiple diagnosis can we list “123”?
Answer 3: CMS instructions say to enter one
diagnosis reference number per line item.
Question 4: In your example of Item 32 there is a number below the address, give an example of what this number might be.
Answer 4: This field is also used when a supplier is a
certified mammography screening center, enter the 6 digit Food and Drug
administration (FDA) approved certification number. The number listed in the example is a
mammography certification number.
Question 5: Did you state that if PIN numbers are listed in Item
33, it should not be in Item 24k?
Answer 5: Item 24k is to be completed when
a provider is part of a group of providers.
Enter the number of a performing provider in Item 24k. When a provider is NOT part of a group and is
in a solo practice, Item 24k is not required.
Question 6: Are
there any boxes that are extremely important for Chiropractors to
complete?
Answer 6: Yes, Items 14, 17, 17a, 19, 21,
and 24D.
Please refer to the Chiropractic Services Billing Guide for specific Instructions: http://www.medicarenhic.com/providers/pubs/chiroguide_jul05.pdf
Question 7: What should be filled in for Item 19 for
Chiropractic Claims?
Answer 7: Enter
either a 6 or 8 digit x-ray date when an x-ray is used to demonstrate the
subluxation rather than a physical examination.
Question 8: Only if an x-ray was used?
Answer 8: Yes, Only
if an x-ray was used to demonstrate a subluxation.
Question 9: In Item 12, if I have a signature on file,
which date do I put? Also, if I
resubmit, which date to I fill in then?
Answer 9: Use the
date the patient signed the notification for both situations.
Question 10: In
Item 24e, will claims be rejected if more than one reference number is used?
Answer 10: Not
currently, however, this will change in the future.
Question 11: If Item 14 is left blank, will claims be
rejected since we are a psychology practice, with ongoing patients? Do we use the first date of service for the
patient?
Answer 11: Item 14 is
not required for mental health claims.
Question 12: We have
not received our Fee Schedule CD, are you still sending them out?
Answer 12: The CD is still being sent out. The CD will not contain a fee schedule. To view the fee schedule, please visit our
website at: http://www.medicarenhic.com/cal_prov/fee_sched.shtml
Question 13: For purposes of timeliness billing, if we
received a MA130 Denial, is this considered a timely submission which it allows
us to fix the claims after the deadline? Will the claim not even be in the system for
us to fix it if we receive a MA130 denial.
If we attempt to fix a MA130 Denial will we get a timeliness denial?
Answer 13: MA130 is a rejected claim, claims are
rejected for missing or invalid information.
Rejected claims must be corrected and resubmitted and will not hold a
submission date for your corrected claim.
Claims must be submitted correctly, within one year of the date of
service to not be reduced by 10%.
Question 14: How can
I access the E-Learning Slides?
Answer 14: By visiting our website at
http://www.medicarenhic.com/cal_prov/education_online.shtml.
Question 15: Are any
Items on the CMS-1500 form important for a DO to complete in order to get paid?
Answer 15: Claims forms should be completed as required
in the CMS-1500 form guide. DO’s have no
special instructions for completing the CMS-1500 form.
Question 16: Are
handwritten claims submitted on the CMS-1500 form scanned or entered via data
entry?
Answer 16: They are keyed into the system by hand.
Question 17: Is
there a place on the CMS-1500 form to add subluxation codes?
Answer 17: Yes, Item 21.
Subluxation codes are considered ICD-9-CM codes.
Question 18: What
database system does Medicare look at to see if patients have concurrent
Medicare and Medical coverage as claims come in? What triggers a claim to automatically cross
over to Medi-Cal?
Answer 18: NHIC receives a patient’s Medicare
eligibility from the Common Working File (CWF).
When a patient has Medi-Cal, we will automatically cross claims over to
the Medi-Cal systems when Medi-Cal sends us an electronic tape with the
Medi-Cal patient’s Medi-Cal eligibility information.
Question 19: Our
computer prints the information except for the last time the patient saw their
physician, I write this in. However, our
claims always come back with missing data.
Is this because we write in the date?
How can we avoid this in the future, if we have to continue to write in
the date?
Answer 19: Check with your software vender to have the
ability to add the date. This may cause
a claim to reject for missing information.
You can call customer service to find out specifically why the claims are
being returned to you.
Question 20: How do I
report a change of billing address?
Answer 20: By completing the appropriate sections of
the 855I or 855B and submit the application within 60 days prior to the change
of address.
Question 21: Do you
have a contact number for Medi-Cal?
Answer 21: Please
look in the phone book to find your local Medi-Cal contact information.
Question 22: If we
start electronic billing, what is our first step?
Answer 22: Contact Electronic Data Interchange
(EDI). Visit the EDI website at: http://www.medicarenhic.com/edi/index.shtml
Question 23: What
hours can providers check patient eligibility for Medicare Part B claims?
Answer 23: You can call the Interactive Voice Response
Unit, 877-591-1587(NCA)
and 866-502-9054(SCA.) This is available 24 hours a day. The telephone number for Customer
Service Representatives is 1-877-527-6613. They are available from 8:00 AM –
4:30PM, Monday through Friday.
Question 24: When
transitioning between billing companies, we submit paper claims. How long do we have until we are required to
submit electronic claims?
Answer 24: Medicare Part B providers who have more than
10 full time employees are required to submit claims electronically. Small providers, 10 or fewer employees, are
not required to submit electronic claims. However, larger providers may receive
denials for not submitting electronic claims, there are a few exemptions and
this scenario does not seem to fall within the exemptions listed. Please view the following links for more
information:
http://www.cms.hhs.gov/medlearn/matters/mmarticles/2005/MM3815.pdf
http://www.cms.hhs.gov/medlearn/matters/mmarticles/2005/MM3440.pdf
Question 25: If a
patient has secondary insurance, how do we bill?
Answer 25: Medicare requires a copy of the primary
insurance plan’s Explanation of Benefits to be submitted along with the claim
to Medicare for paper submission. Use
the appropriate Medicare codes and modifiers.
You can view the
Medicare Secondary Payer guide at the following link:
http://www.medicarenhic.com/providers/billing/mspguide_jul05.pdf
Question 26: Item 10,
we usually do not enter “No” when there is no patient condition to warrant us
to complete this Item, should we check the boxes?
Answer 26: Yes, according to the CMS instructions for
completing the CMS-1500 form, Item 10 should be checked, Yes or No.
Question 27:
Answer 27: The date can be either 6 or 8 digits for the
date last seen by the patient’s physician.
Question 28: We’ve been
told that we must put “date last seen” and the UPIN and a date. Is the “date last seen” part of this
requirement.
Answer 28: No, you do not need to enter the words “date
last seen” in this Item. The only
requirement for physical therapy claims is the UPIN number and the actual date
the physician last saw the patient.
Question 29: When is
the National Provider Identifier (NPI) number required?
Answer 29: You can enroll to receive this number now,
however it is not required on claims sent to NHIC until May 23, 2006. Until this time, please continue to submit
your current Medicare Provider numbers on your claims.
For more information
about the NPI number, please visit this website: http://www.cms.hhs.gov/providers/npi/default.asp
Question 30: We
receive denial message MA27, Entitlement number or name shown on this claim is
invalid.
Answer 30: The MA27 denial
message reads: “Missing/incomplete entitlement number or name shown on the
claim”. This message is related to the patient’s entitlement to Medicare. Two important factors to consider is the
patient’s Medicare number and/or patient’s name.
Item 1a – Insurance ID number: Enter the patient’s Medicare
Health Insurance Claim Number (HICN) whether Medicare is primary or secondary
payer.
The patient’s name
also needs to be entered as it is shown on the patient’s Medicare card. If you use a nick name or a name not as it is
seen on the Medicare card, this will not match what is in our system and claims
will deny.
Item 2 – Patient’s Name: Enter the patient’s last name,
first name, and middle initial (if any), as shown on the patient’s card.
Patient’s Medicare
number needs to be entered on the claim as it is seen on the patient’s Medicare
card. You do not need to enter hyphens,
however be sure to use the letter suffix at the end of the Medicare number.
Question 31: Are the
physical therapy caps reinstated?
Answer 31: Yes, they are. The Physical Therapy and Speech Therapy is
$1740 and Medicare pays 80% after the Part B deductible.
Question 32: We did
not receive our fee schedule this year?
Is there a place it can be accessed?
Answer 32: Yes, this is available on our website at:
12/29/2005
Question 23
revised – 1/12/06