CMS-1500 and UB-04 elements, payer types, denials and appeals, fraud and abuse laws, NCCI edits and code compliance.
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- What is the CMS-1500 claim form used for?
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Billing professional and outpatient services (physicians and non-institutional suppliers) to payers- On the CMS-1500, what information goes in Box 21?
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The patient's diagnosis codes (ICD-10-CM)- On the CMS-1500, what does Box 24E contain?
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The diagnosis pointer, linking each service line to the diagnosis code(s) in Box 21 that justify it- On the CMS-1500, what is reported in Box 33?
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The billing provider's name, address, and NPI- On the CMS-1500, what is reported in Box 24J?
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The rendering provider's NPI- On the CMS-1500, what is Box 11 used to report?
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The patient's other insurance information, for coordination of benefits- What is the UB-04 (CMS-1450) claim form used for?
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Billing institutional services, such as hospital inpatient and outpatient facility charges- On the UB-04, what does Form Locator 4 (type of bill) indicate?
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The type of facility, bill classification, and frequency of the claim (a 3-4 digit code)- What is the purpose of revenue codes on a UB-04?
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They identify the specific department or type of service/accommodation billed, such as a room or the emergency room- On the UB-04, what is reported in Form Locator 1?
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The billing provider's name, address, and telephone number- What do occurrence codes on a UB-04 report?
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A specific event related to the claim and its date, such as an accident or onset of symptoms- What do condition codes on a UB-04 report?
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Special circumstances or conditions that affect how the claim is processed- What do value codes on a UB-04 report?
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Numeric values related to the claim, such as covered days or deductible amounts- What does Medicare Part A primarily cover?
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Inpatient hospital, skilled nursing facility, hospice, and some home health care- What does Medicare Part B primarily cover?
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Physician services, outpatient care, and medical supplies
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