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The Revised CMS-1500 Form

The Revised CMS-1500 Form. ATCMS Seminar March 30, 2014 By Ling Zheng, L.Ac. The Revised CMS-1500 Form. General information regarding the revised CMS-1500 form What are the differences between the CMS-1500 form (02/12) and the CMS-1500 form (08/05) How to fill out the new form

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The Revised CMS-1500 Form

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  1. The Revised CMS-1500 Form ATCMS Seminar March 30, 2014 By Ling Zheng, L.Ac.

  2. The Revised CMS-1500 Form • General information regarding the revised CMS-1500 form • What are the differences between the CMS-1500 form (02/12) and the CMS-1500 form (08/05) • How to fill out the new form • How to get the new form and the online information

  3. General Information The Office of Management and Budgets (OMB) has approved a revised CMS-1500 health insurance claim form (version 02/12) to replace the current form (version 08/05). Healthcare providers are required to use the revised CMS-1500 form for their medical reimbursement since April 1, 2014

  4. How to fill out the new form • What are differences between the revised form and the original one • How to fill out the changed items on the revised claim form

  5. How to fill out the new form Add a QR Codes symbol to the top, left hand margin of the claim form

  6. How to fill out the new form Item 1: Minor changes to the wording of payer ID number requirements

  7. How to fill out the new form Item 8: Changed to “RESERVED FOR NUCC USE”, Removed “PATIENT STATUS” from the original form Description: This field is reserved for NUCC use

  8. How to fill out the new form Item 9b and 9c: Replaced with “RESERVED FOR NUCC USE” Removed “EMPLOYER’S NAME OR SCHOOL NAME” from the original form Description: The field is reserved for NUCC (National Uniform Claim Committee) use

  9. How to fill out the new form Item 10d: Changed to “CLAIM CODES (Designated by NUCC)” Instruction: When applicable, use to report appropriate claim codes designated by the NUCC

  10. How to fill out the new form For the workers’ Compensation claims, condition Codes are required when submitting a bill that is a duplicate or an appeal. (Original Reference Number must be entered in Box 22 for these conditions). Note: Do not use Condition Codes when submitting a revised or corrected bill.

  11. How to fill out the new form Original claim: None Duplicate claim: W2 Appeal-Level 1: W3 Appeal-Level 2: W4 Appeal-Level 3: W5

  12. How to fill out the new form

  13. How to fill out the new form Item 11b: Changed to “OTHER CLAIM ID (Designated by NUCC)” Instruction: For workers’ compensation or property & casualty (such as No-Fault), should enter qualifier “Y4” and claim number assigned by the payer

  14. How to fill out the new form

  15. How to fill out the new form Item 14: Minor changes to layout of field Instruction: Enter the first date of the present illness, injury, or pregnancy (LMP), then enter the following applicable qualifier Onset of current symptoms or illness: 431 Last menstrual period: 484

  16. How to fill out the new form

  17. How to fill out the new form Item 15: Changed to “OTHER DATE” Removed “IF PATIENT HAS HAD SAME OR SIMILAR ILLNESS, GIVE FIRST DATE” from the original form Instruction: May enter the qualifier “454”, then enter the date of the initial treatment

  18. How to fill out the new form

  19. How to fill out the new form Item 17: Added a field to report a qualifier to identify which provider is being reported Instruction: Enter the name of provider who referred or ordered the service on the claim, then enter the applicable qualifier to identify which provider is being reported

  20. How to fill out the new form DN Referring provider DK Ordering provider DQ Supervising provider

  21. How to fill out the new form

  22. How to fill out the new form Item 19: Replaced with “ADDITIONAL CLAIM INFORMATION (Designated by NUCC)” Removed “RESERVED FOR LOCAL USE” from the original form Instruction: Don’t need to fill it unless it is required

  23. How to fill out the new form Item 21: Added eight additional lines for diagnosis of illness/injury Instruction: Enter the applicable ICD indicator to identify which version of ICD codes is being reported, in the upper right-hand portion of the field

  24. How to fill out the new form ICD Indicator: 9 ICD-9-CM 0 ICD-10-CM

  25. How to fill out the new form Enter the ICD codes to identify the patient’s diagnosis and/or condition. List no more than 12 ICD-9-CM or ICD-10-CM codes relating to the service(s) on the claim

  26. How to fill out the new form

  27. How to fill out the new form Item 24E: DIAGNOSIS POINTER Instruction: Enter the diagnosis code reference letter (such as AB…) as shown in item 21 to relate the date of services and the procedures performed. The field allows for the entry of up to 4 characters in unshaded area

  28. How to fill out the new form

  29. How to fill out the new form Item 30: Replaced with “Rsvd for NUCC Use” Removed “BALANCE DUE” from the original form Description: This field is reserved for NUCC use

  30. How to get the new claim form How to get the CMS-1500-Form (version 02/12)? May order the forms at: www.medicalartspress.com

  31. Online reference information Reference Information: Please read <<1500 Health Insurance Claim Form Reference Instruction Manual for Form Version 02/12>> provided by National Uniform Claim Committee (NUCC)

  32. Online reference information The online information is available at: http://www.findacode.com/cms1500-claim-form/instructions-02-12/1500_claim_form_instruction_manual_2012_02.pdf

  33. The Revised CMS-1500 Form Thank you !

  34. ICD-10-Codes Commonly Used By Acupuncturists ATCMS Seminar March 30, 2014 By Ling Zheng, L.Ac.

  35. Highlights of the talk • General information regarding ICD-10-Coding system • To introduce <<List of ICD-10 Codes Commonly Used by Acupuncturists>> • Acupuncture coverage policy provided by different major insurance companies • Online information regarding ICD-10-Codes

  36. General Information • Brief introduction of ICD-10-CM • ICD-10-CM Coding system • What are differences between ICD-10-CM and ICD-9-CM • The deadline for using the ICD-10-Codes

  37. Brief Introduce ICD-10-CM • ICD Codes: International Classification of Diseases (ICD) codes is a coding system to indicate diagnoses, symptoms, injuries, and other conditions. This coding system is developed and published by WHO. • ICD-10: is the 10th revision of ICD coding system developed by WHO on January 1, 1999

  38. Brief Introduce ICD-10-CM • ICD-10-CM: Based on ICD-10 coding system published by WHO, U.S. Government (the National Center for Health Statistics, NCHS) published the ICD-10-CM (International Classification of Diseases, 10th revision, Clinical Modification) on January 1, 2014.

  39. ICD-10-CM Coding System • ICD-10-CM is an alphanumeric classification system. It consists of up to 7 characters. • The first character is a letter followed by numbers or alpha characters. • The injury-ICD-code should be added an appropriate 7th alpha character (such as A, D, or S) according to the different statuses

  40. What are differences between ICD-10-CM and ICD-9-CM • ICD-10-CM codes consist of up to 7 alphanumeric characters, and ICD-9-CM codes consist of up to 5 alphanumeric characters only • ICD-10-CM contains subcategories codes to indicated conditions on right side or left side, and upper or lower extremity

  41. What are differences between ICD-10-CM and ICD-9-CM • Expanded injury codes • Add the 7th alpha character on injury codes to describe patients’ status • Add the external cause codes to describe the cause, the intend, the place of injury occurrence

  42. When Should I Use ICD-10-CM Since October 1, 2014, healthcare providers are required to use ICD-10-CM codes for medical reimbursements

  43. ICD-10-CM Codes Commonly Used by Acupuncturists • Why dose ATCMS provide the <<List of ICD-10-Codes Commonly Used by Acupuncturists>> to our AOM colleagues? To help AOM practitioners using the new ICD codes easily and correctly, ATCMS offer this reference coding material to our colleagues

  44. ICD-10-CM Codes Commonly Used by Acupuncturists • The reference coding material has listed about 400 ICD-10-CM codes commonly used by acupuncture practitioners • Considering the purpose of acupuncture reimbursements, the listed codes have been divided to the following three parts: (1) Pain and related conditions; (2) Injuries; and (3) Other conditions

  45. Part I: Pain and the Related Conditions • Pain management is the most common case treated at acupuncture clinic • In general, some major insurance companies consider acupuncture as a medically necessary procedure for treating pain and the related conditions, such as osteoarthritis, migraine, neck pain or lower back pain

  46. Part II: Injuries • Injuries is common cases treated at acupuncture clinic also • These ICD codes are used for acupuncture reimbursements on No-Fault or workers’ compensation cases • Some major insurance policies also cover acupuncture for injuries

  47. Part II: Injuries • All injury codes should be 7-character-codes • The 7th character of injury codes should be a letter “A”, “D”, or “S”, according to the following different statuses:

  48. Part II: Injuries • For the status of initial encounter, the 7th character of the code should be “A” For Example: Strain of unspecified muscle and tendon at right leg level with the status of initial encounter, the ICD code should be “S86.911A” (S86.911 plus A)

  49. Part II: Injuries • For the status of subsequent encounter, the 7th character of the code should be “D” For Example: Strain of unspecified muscle and tendon at right leg level with the status of subsequent encounter, the ICD code should be “S86.911D” (S86.911 plus D)

  50. Part II: Injuries • For the status of sequel, the 7th character of the code should be “S” For Example: Strain of unspecified muscle and tendon at right leg level with the status of sequel, the ICD code should be “S86.911S” (S86.911 plus S)

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