Questions and Answers
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)
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.
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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?
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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.
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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?
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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?
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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.
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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.
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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.
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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.
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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)____
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What is the coding process for CMS-1500?
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What does the UB-04 form bill for?
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What are the coding processes for UB-04?
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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.
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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.
