Revised CMS-1500 Form Creates Selling Opportunities
Headquartered in Oxnard, Calif., TFP Data Systems was instrumental in assisting the National Uniform Claim Committee in revising the CMS-1500 billing form, which must be submitted by “non-institutions”—such as private physicians’ offices, chiropractors, physical therapists, ambulance services, dentists and nursing homes—when submitting claims.
“This is the biggest opportunity in CMS forms since the December 1990 revision of the 1500,” said Jim Magdaleno, sales and marketing rep. “TFP Data Systems is the first manufacturer to have the new CMS-1500 ready for shipment.” He noted that more than 20 billion health insurance claims will be submitted and processed this year.
One of the major reasons for changing the CMS-1500 is to accommodate the new National Provider Identifier Number (NPI), as well as to insure strict form specification compliance. (Many health plans, including Medicare, Medicaid, private health insurance issuers and all health-care clearinghouses must accept and use NPIs, which replace current health-care provider identifiers, in standard transactions by May 23, 2007.)
Magdaleno explained that by Oct. 1, 2006, health plans, clearinghouses and other information support vendors should be ready to handle and accept the revised claim form. Between Oct. 1 and March 31, 2007, providers can use either the existing version or the revised version of the CMS-1500 claim form. “But, by April 1, the current version of the CMS-1500 will be discontinued and only the revised form is to be used,” he continued. “All rebilling of claims should use the revised form from this date forward, even though earlier submissions may have been on the current form.”
The proposed Medicare implementation time line is for the new CMS-1500 form to be effective for optional use starting January 2 through March 30, but use of the document will be required starting April 2, 2007.
“Providers will need to check with their payer and/or clearinghouses to determine when they will begin to accept the revised forms,” suggested Magdaleno.