General Category > General Questions
New to Billing using the CMS 1500
kkelley831:
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?
shanbull:
--- Quote from: kkelley831 on February 14, 2014, 05:55:36 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?
--- End quote ---
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 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?
kkelley831:
This information is very helpful. I do not have any experience with CPT/HPCS, ICD-9, and modifier codes.
PMRNC:
--- Quote ---This information is very helpful. I do not have any experience with CPT/HPCS, ICD-9, and modifier codes.
--- End quote ---
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.
shanbull:
--- Quote from: PMRNC on February 19, 2014, 10:20:40 AM ---
--- Quote ---This information is very helpful. I do not have any experience with CPT/HPCS, ICD-9, and modifier codes.
--- End quote ---
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.
--- End quote ---
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.
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