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Tuesday, July 9, 2013

CMS 1500 claim form gets an update

The National Uniform Claim Committee has updated the CMS-1500 insurance claim form to accommodate the new ICD-10 codes and current standard for electronic health care transactions.

Known as "version 02/12" and approved by both the Centers for Medicare & Medicaid Services (CMS) and the Office of Management and Budget, the updated claim form includes revisions designed to improve the accuracy of data reported. 

Two changes of note:

• Physicians can identify in Item 21 whether they are using ICD-9 or ICD-10, which will come in handy during the transition to the new codes in October 2014. As noted in a previous post, it depends on the actual date of service whether you use ICD-9 or ICD-10 on claims submitted after Oct. 1, 2014.

• The diagnosis field in Item 21 will allow up to 12 codes. The current form (version 08/05) is limited to four.

Other revisions will also help with accuracy. For instance, you will now be able to identify in Item 17 the role of the provider as “Ordering,” “Referring,” or “Supervising."

The start date for using the revised form has not yet been announced. However, Medicare anticipates implementing the revised claim form as follows:

• Jan. 6, 2014 – Medicare begins receiving and processing paper claims submitted on the revised form.

• Jan. 6, 2014, through March 31, 2014 – Providers can use either the current form or the revised one.

• April 1, 2014 – Only the revised form can be used.  

These dates are tentative and subject to change. CMS will provide more information as it is available. Also, CMS is updating the Medicare Claims Processing Internet Only Manual to instruct contractors and physicians regarding how to complete the revised form online and will post this information on the CMS website when it is available.

If you still submit paper claims, you would be wise not to purchase large quantities of the current form. If your practice submits electronic claims, you should speak to your software vendor to determine how and when your practice management system will be updated to accommodate the revised form.

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians

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The views expressed here do not necessarily reflect the opinion of FPM or the AAFP. Some payers may not agree with the advice given. This is not a substitute for current CPT and ICD-9 manuals and payer policies. See Terms of Use.