HCR 203 Week 2 CMS-1500 Claim Form Worksheet

Resource: CMS-1500 completed claim form and this week’s readings

Complete the University of Phoenix Material: CMS-1500 Claim Form Worksheet.

Click the Assignment Files tab to submit your assignment.

CMS-1500 Claim Form Worksheet

Complete Part A, B and C of this worksheet.

Resource: CMS-1500 Completed Claim Form and Ch. 7 and 17 of Medical Insurance

Part A: CMS-1500 Claim Form

Imagine you are working at a local medical office as a billing specialist. You are asked to audit the CMS-1500 claim form completed by a new employee to ensure it was completed correctly.

Review the Patient Information, Provider Information and Treatment Information.

Review the CMS-1500 Completed Claim Form document.

Determine if the employee input the correct data and completed correctly the data fields in the claim form.

Complete the table below by listing the data field completed incorrectly and providing both the incorrect entry and correct entry. An example has been provided.

Write 50- to 150-word response to the following question. Be clear and concise, use complete sentences, and explain your answers using specific examples.

Cite any outside sources. For additional information on how to properly cite your sources check out the Reference and Citation Generator resource in the Center for Writing Excellence.

1. Explain the importance of complete and accurate completion of the claim form prior to claim processing.

2. How can the payment plan affect reimbursement?

Part B: Patient and Insurance Information Section of the CMS-1500 Claim Form

Review the Patient Information.

Patient Information

Determine the appropriate content for each Data Field Number listed. An example has been provided.

Part C: Physician or Supplier Information Section of the CMS-1500 Claim Form

Review the note below.

Determine the appropriate content for each Data Field Number listed. An example has been provided.