The
information in this module covers the "hot spots"– the areas
of which you need to be particularly aware – on the CMS 1500 claim form
(or electronic equivalent). We'll also cover modifier usage and the claims appeals
process. The
information in this module covers the "hot spots"– the areas
of which you need to be particularly aware – on the CMS 1500 claim form
(or electronic equivalent). We'll also cover modifier usage and the claims appeals
process.
This module will help you prepare and submit claims correctly for processing, thereby avoiding appeals.
Unless requested, no documentation is required with your claims. Your claims should be processed according to established payment thresholds unless errors exist in the way the claim forms are completed.
Down coding, up coding, or billing with a single code regardless of the patient's condition, are incorrect practices, even if doing so gets your claims paid. These billing practices can cause you to look different from other providers and may subject you to other types of review. Bill for and document the services you render at the level you provide them.
Note: Where the CMS 1500 claim form is referenced in this module, the directions also apply to the electronic equivalent.