Author Topic: 1500 form facility urgent care billing  (Read 2294 times)

mpekar

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1500 form facility urgent care billing
« on: March 20, 2014, 05:35:53 AM »
I am trying to determine the proper billing format for a 1500 claim for urgent care charges for a hospital facility.  These are not the professional charges for the physician.  I am having difficulty understanding how the urgent careís claim distinguishes itself from the professional physicianís bill which I imagine is also being billed and also on a 1500.  Can you tell me what POS to use for the urgent care charges as well as what goes in box 25, 31, 32, and 33? And how this is different from the professional physicianís claim for the same visit?  I have been told that POS 20 should be used on the facility charges and that the physicianís name still goes in 31 and the facility info goes in 32, would this be correct? I may be wrong but I believe all the charges are to be billed under the hospitalís TIN.  I am thinking that perhaps the facility and physician(physician billing group) and the urgent care all need their own separate NPI and perhaps it only the NPI in 33 which will be different.  Please help!

HeidiK

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Re: 1500 form facility urgent care billing
« Reply #1 on: March 20, 2014, 08:24:25 AM »
Good Morning!

I tried to attach a file but it was too large for what is allowed here.  If you go to the first link below and then click on the first one listed (Medicare Billing: 837P and Form CMS-1500) it will take you to a great summary of the CMS1500 form and there is even a link to a webinar about proper filing straight from CMS included towards the end.  (Explanation for the Place of Service codes is also explained.) CMS offers a great learning network and it is all for FREE!  Best to get information straight from the source when you can, just saying!  : )

http://www.cms.gov/site-search/search-results.html?q=cms%201500

This link will take you to the actual Medicare chapter describing how to properly complete the CMS 1500.  Lengthy read, but many more details than above and important information for billers to know for proper claim submission.  Scroll through to see if you need it and if not, send it to the recycle bin!  Lol!

http://www.cms.gov/Medicare/Coding/place-of-service-codes/

Hope this helps!

Heidi Kollmorgen, CCS-P

Heidi Kollmorgen, CCS-P
AHIMA Approved ICD-10 Trainer
hdmedicalcoding.com