Medical Billing Forum

General Category => General Questions => Topic started by: kkelley831 on February 14, 2014, 02:55:36 PM

Title: New to Billing using the CMS 1500
Post by: kkelley831 on February 14, 2014, 02:55:36 PM
I am new to the billing world. I have been trying to learn how to fill out the CMS 1500. I am having  difficulty figuring out the Provider ID and NPI/non-npi codes what is the best way to find and understand this information?
Title: Re: New to Billing using the CMS 1500
Post by: shanbull on February 14, 2014, 03:06:00 PM
I am new to the billing world. I have been trying to learn how to fill out the CMS 1500. I am having  difficulty figuring out the Provider ID and NPI/non-npi codes what is the best way to find and understand this information?

To summarize a complicated issue, NPI's have essentially replaced other Provider ID #'s. Many insurers have stopped issuing their own version of provider ID's and they all accept NPI's now. Some providers do still have insurance-specific ID #'s from before the switch to one type of ID, but insurers are required to accept NPI #'s

For identification purposes, the NPI and Tax ID # (also known as TIN or EIN) of the practice and the NPI of the individual provider are usually all you're going to need. Of course, even these require extra explanation, because there are different types of NPI's - rendering NPI's, billing NPI's, group NPI's... I'll let one of the people more familiar with those tackle the explanation.

This is the official website for PECOS, the issuing authority for NPI numbers: https://pecos.cms.hhs.gov/pecos/login.do (https://pecos.cms.hhs.gov/pecos/login.do) scroll down to the bottom of the page and there are some helpful resources to help you understand what an NPI is.


I will give you an example of how boxes 25-33 look for our claims:

25. Our Tax ID #, box "EIN" is checked
26. Our system's patient account # (this is for internal purposes only)
27. "Yes" is always checked
28 - 30. Pretty self-explanatory but let us know if you have questions
31. We use an electronic system so this space is the provider's name spelled out followed by the abbreviation for his/her credentials, the date is today's date (whatever today happens to be when you're filling out the claim)
32. Our clinic name & address. Our group NPI goes in box A, box B is blank.
33. Identical to 32, with our clinic phone # added.

The rendering provider's individual NPI number is entered at the CPT-level, in the white box right next to "NPI" under column J.


As far as CPT/HPCS, ICD-9, and modifier codes, do you have any background with those?
Title: Re: New to Billing using the CMS 1500
Post by: kkelley831 on February 19, 2014, 06:25:52 AM
This information is very helpful. I do not have any experience with  CPT/HPCS, ICD-9, and modifier codes.
Title: Re: New to Billing using the CMS 1500
Post by: PMRNC on February 19, 2014, 07:20:40 AM
Quote
This information is very helpful. I do not have any experience with  CPT/HPCS, ICD-9, and modifier codes.

You are going to need to start at the beginning. If you have not already taken a course / classes I suggest you do so. The coding is the backbone to telling the carriers what was done and what was wrong and determines reimbursement.
Title: Re: New to Billing using the CMS 1500
Post by: shanbull on February 19, 2014, 12:25:11 PM
Quote
This information is very helpful. I do not have any experience with  CPT/HPCS, ICD-9, and modifier codes.

You are going to need to start at the beginning. If you have not already taken a course / classes I suggest you do so. The coding is the backbone to telling the carriers what was done and what was wrong and determines reimbursement.

Agreed. What specialty are you billing for and how many providers? Will you only be doing paper claims or will you be expected to do electronic claims too? We can direct you to some good resources but a basic billing course will be very helpful for you.
Title: Re: New to Billing using the CMS 1500
Post by: kkelley831 on February 20, 2014, 08:59:26 AM
We are billing for mental health services. The amount of providers would just depend on the number of clients we have with insurance. I have found a program that is electronic that assists with filling in the CMS 1500 form but nothing more than if I were to write it out. I will look into finding a billing class. If you guys have any suggestions please let me know.
Thank you again for all of your help!!
Title: Re: New to Billing using the CMS 1500
Post by: Alice Scott on February 20, 2014, 10:00:12 AM
Actually we offer online medical billing courses at www.medicalbillingstudycourse.com (http://www.medicalbillingstudycourse.com)
We offer 10 individual courses or 4 bundled courses with email and phone support.  We also offer ongoing  support with our forum after the courses are completed.  The courses were written by Michele Redmond, Merry Schiff and me.  Linda Walker also helped on the HIPAA course.  Merry will be glad to give you more info.  She's out of the office today.
Title: Re: New to Billing using the CMS 1500
Post by: shanbull on February 20, 2014, 10:12:12 AM
We are billing for mental health services. The amount of providers would just depend on the number of clients we have with insurance. I have found a program that is electronic that assists with filling in the CMS 1500 form but nothing more than if I were to write it out. I will look into finding a billing class. If you guys have any suggestions please let me know.
Thank you again for all of your help!!

To be honest I've never taken an actual billing class, but I'm not the norm. The owners of this forum do offer some courses, they can fill you in on what they have to offer for introductory level courses.

Mental health is one of the more straightforward specialties to bill for, so it's a good way to get into this stuff. Also the field is likely to grow because due to the ACA, reimbursement for the specialty has improved and so has coverage for patients who need mental health services. The great thing about billing for it is it's really based on time more than the content of the treatment, so it's much easier to know what to code than for other specialties.

The Medicare Learning Network has some fantastic info sheets on all kinds of topics and some webinars, most of their materials are free: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNGenInfo/index.html?redirect=/MLNGenInfo (http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNGenInfo/index.html?redirect=/MLNGenInfo)

Also, to explain Medicare: CMS Medicare is the national website - all of the policy information and standards apply nationwide. However, you also have a local Medicare jurisdiction that a contracted company oversees. The company varies by geographic location/state. Your local Medicare jurisdiction has "local coverage determinations" that also apply. So when you are looking into Medicare policies on issues, make sure you are checking both the national guidelines and any LCD's for your jurisdiction. Medicare is generally where you're going to start researching a specific topic because more often than not, private insurers default to Medicare guidelines anyway.


Here are some good introductory explanations on coding:

http://www.asha.org/practice/reimbursement/coding/code_intro.htm (http://www.asha.org/practice/reimbursement/coding/code_intro.htm)

http://www.medicalbillingandcodingu.org/introduction-to-hcpcs-level-i-coding/ (http://www.medicalbillingandcodingu.org/introduction-to-hcpcs-level-i-coding/) (this site has links to several schools on billing/coding, I am not endorsing any of them)

http://highered.mcgraw-hill.com/sites/dl/free/0073374504/893447/Chapter03.pdf (http://highered.mcgraw-hill.com/sites/dl/free/0073374504/893447/Chapter03.pdf)

Most of these examples are not specific to mental health billing, but having a good general understanding of how things work is important so that when you get into the specialty details, you can focus on what is unique to that specialty.

Edit: Alice beat me to it about the courses offered here. I haven't taken one but I can tell you the ladies are around here all the time answering questions, so they are available to clarify anything you might have questions about. This is not necessarily true of other billing courses.
Title: Re: New to Billing using the CMS 1500
Post by: Michele on February 20, 2014, 10:21:57 AM


Also the field is likely to grow because due to the ACA,

Because by the time it's all sorted out we will all be seeking mental health services.   ;D  Sorry I couldn't resist. 
Title: Re: New to Billing using the CMS 1500
Post by: Merry on February 20, 2014, 11:33:12 AM
Out of the office but thank goodness for cell phones. I would be happy to help you if you have any questions about the medical billing course that we have.

Merry
Title: Re: New to Billing using the CMS 1500
Post by: shanbull on February 21, 2014, 09:25:51 AM


Also the field is likely to grow because due to the ACA,

Because by the time it's all sorted out we will all be seeking mental health services.   ;D  Sorry I couldn't resist.
LOL that and ICD-10 might lead to some nervous breakdowns this year, I can see it!
Title: Re: New to Billing using the CMS 1500
Post by: Michele on February 22, 2014, 02:53:17 PM
I think the doctors will be seeking the mental health services in October!  From my view, most don't realize what's coming.  And they should because there is certainly enough talk out there about it.  We keep sending notices to our providers.
Title: Re: New to Billing using the CMS 1500
Post by: PMRNC on February 22, 2014, 03:25:06 PM
I don't think this is going to effect physicians that took the precautions of redoing their financial policies before 1/1. I don't even think those physicians will have a problem with the grace period. We have patient's bringing in proof the premium was submitted with each visit. We've setup and arranged newer payment policies to accommodate the higher deductibles, coinsurance, etc. I think only the ones that waited till it hit will be in trouble.  I've so far got smooth sailing so far and we've seen a few exchange plan patients.
Title: Re: New to Billing using the CMS 1500
Post by: Michele on February 23, 2014, 06:12:39 AM
I meant when the ICD10's are implemented.  Drs are so used to coding with the ICD9s.  A lot of the smaller offices are not prepared yet.