This assignment will provide you with insight into the use of data as it flows throughout the revenue cycle. Information gathered at the time of registration (demographics, insurance information, and admission date), charge capture throughout treatment and provision of services, the application of ICD-10, CPT, and HCPCs codes as well as provider information culminates in the claim form that is finalized and submitted for payment.
Prepare Insurance Claims for Submission
This assignment will provide you with insight into the use of data as it flows throughout the revenue cycle. Information gathered at the time of registration (demographics, insurance information, and admission date), charge capture throughout treatment and provision of services, the application of ICD-10, CPT, and HCPCs codes as well as provider information culminates in the claim form that is finalized and submitted for payment.
In this assignment, you will prepare two CMS-1500 and two UB-04 insurance claim forms using the data in four case scenarios.
To complete this assignment, do the following:
Download the zip file containing the four case scenarios below.
Case Scenarios
Download the CMS-1500 and UB-04 forms below.
CMS-1500 Form
UB-04 Form
Save two copies of each form on your computer (one for each of the two CMS-1500 scenarios and one for each of the two UB-04 scenarios). Save each form with a unique file name. Include the Case ID and form type in the file name (for example, CMS15001a, CMS15001b, UB2a, UB2b).
Download the instructions for completing the CMS-1500 and UB-04 forms below.
Instructions for Completing the CMS-1500 and UB-04 Forms
Using Adobe Acrobat Reader, enter the information from the case scenario into the appropriate field on the corresponding form. Refer to your readings for Physician and Hospital Medical Billing for information on CMS-1500 and UB-04 form locators and required information.
(If you do not have Adobe Acrobat Reader, download it from the Adobe website.)
For the CMS-1500 forms: Enter your name and date in the box in the upper left of the form. Enter the Case ID in the box in the upper right. Complete all pertinent fields #1-11d and 14-33 according to the data in the case and the guidelines you downloaded in Step 4.
For the UB-04 forms: Enter your name, the date, and the Case ID in the “Responsible Party” field (field 38) on the form. Complete all pertinent fields according to the data in the case and the guidelines you downloaded in Step 4.
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