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Questions and Answers
What is the CMS-1500 form?
What is the CMS-1500 form?
The standard health insurance form used by health-care providers to bill for services, equipment, and supply charges.
Which of the following steps are involved in coding/billing for healthcare service at the physician's office? (Select all that apply)
Which of the following steps are involved in coding/billing for healthcare service at the physician's office? (Select all that apply)
The physician's office only uses the CMS-1500 form for billing.
The physician's office only uses the CMS-1500 form for billing.
True
The billing and coding process at the physician's clinic begins with the procedure codes from CPT.
The billing and coding process at the physician's clinic begins with the procedure codes from CPT.
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Large physician's offices will have a different billing procedure than small ones.
Large physician's offices will have a different billing procedure than small ones.
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What are the steps for coding/billing for healthcare services at an independent facility?
What are the steps for coding/billing for healthcare services at an independent facility?
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A physician who sees patients in outside facilities will have the services coded by his/her own staff.
A physician who sees patients in outside facilities will have the services coded by his/her own staff.
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The physician's staff will use only a CMS-1500 form when billing for his/her work at an outside facility.
The physician's staff will use only a CMS-1500 form when billing for his/her work at an outside facility.
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If a physician brings supplies with him when visiting an outpatient facility, it is billed on a CPT.
If a physician brings supplies with him when visiting an outpatient facility, it is billed on a CPT.
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What steps are involved in coding/billing for physician services at independent facilities?
What steps are involved in coding/billing for physician services at independent facilities?
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What are the steps for coding/billing for physician professional services?
What are the steps for coding/billing for physician professional services?
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What are the steps for coding/billing for non-physician professional services at independent facilities?
What are the steps for coding/billing for non-physician professional services at independent facilities?
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The ICD-10-PCS codebook is used in the coding and billing process for professional services.
The ICD-10-PCS codebook is used in the coding and billing process for professional services.
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Procedures performed at a physician's office are reported with CPT codes.
Procedures performed at a physician's office are reported with CPT codes.
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The coding and billing for non-physician professional services are coded and billed differently than physician professional services.
The coding and billing for non-physician professional services are coded and billed differently than physician professional services.
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When a physician provides their own supplies while visiting an outpatient facility to provide care, they can code and bill for these supplies.
When a physician provides their own supplies while visiting an outpatient facility to provide care, they can code and bill for these supplies.
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Emergency room services are billed on the UB-04 claim form.
Emergency room services are billed on the UB-04 claim form.
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All physician facility charges are reported on the UB-04 claim form.
All physician facility charges are reported on the UB-04 claim form.
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Facility charges are billed on the CMS-1500 claim form.
Facility charges are billed on the CMS-1500 claim form.
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ICD-10-PCS procedure codes for outpatient services are used only by the facility to track the services rendered and not to determine reimbursement.
ICD-10-PCS procedure codes for outpatient services are used only by the facility to track the services rendered and not to determine reimbursement.
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The charges for Medicare patients seen in ambulatory surgical centers are billed on the CMS-1500 claim form.
The charges for Medicare patients seen in ambulatory surgical centers are billed on the CMS-1500 claim form.
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CMS-1500 form bills for services in (a), (b), (c)____
CMS-1500 form bills for services in (a), (b), (c)____
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What is the coding process for CMS-1500?
What is the coding process for CMS-1500?
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What does the UB-04 form bill for?
What does the UB-04 form bill for?
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What are the coding processes for UB-04?
What are the coding processes for UB-04?
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What is a chargemaster?
What is a chargemaster?
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Study Notes
CMS-1500 Form
- The standard health insurance claim form, also known as the universal claim form.
- Used by health-care providers to bill for services, equipment, and supply charges.
Coding and Billing Steps at Physician Office
- Establish Diagnosis Codes using ICD-10-CM.
- Establish Procedure Codes using CPT.
- Establish Supply Codes using HCPCS if applicable.
- Bill all codes using CMS-1500 form.
Billing Procedures
- Physician offices exclusively use the CMS-1500 form for billing.
- Coding and billing processes begin with the Diagnosis Code from ICD-10-CM, not Procedure Codes.
- Billing procedures are similar for both large and small physician offices if they are owned by the same physician(s).
Independent Facility Coding and Billing
- Steps mirror those of a physician's office:
- Diagnosis Codes from ICD-10-CM.
- Procedure Codes from CPT.
- Supply Codes from HCPCS Level II if applicable.
- Billing with CMS-1500 form.
- Physicians seeing patients in outside facilities may have their services coded by their own staff.
CMS-1500 Form Usage
- Used for billing for outside facilities, including supplies brought by a physician.
- Used for physician services in outpatient surgery and for Medicare patients.
Non-Physician Services
- Non-physician professional services are coded and billed the same way as physician professional services.
Emergency Room and Facility Charges
- Emergency room services are billed on the UB-04 claim form.
- Facility charges are not billed on the CMS-1500 form but on the UB-04 form instead.
- All physician facility charges are reported on the CMS-1500 form.
ICD-10 Codebooks
- The ICD-10-PCS codebook is not used for professional services coding; ICD-10-CM is used instead.
Chargemaster
- Represents a price list for all supplies, services, and equipment utilized in healthcare settings.
Studying That Suits You
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Description
Test your knowledge of essential coding terms and procedures used in physician services. This set of flashcards covers key topics such as the CMS-1500 form and the steps for proper billing and coding in healthcare. Perfect for healthcare professionals looking to sharpen their coding skills.
