CMS 1500 Form Billing Tip Completing Boxes 12 and 13

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Boxes 12 & 13 on the CMS 1500 form are very important and often overlooked. When I say overlooked I mean that most don’t understand the importance of the boxes, and just blindly fill them in. It is important to understand what they mean, and make sure they are completed because they can seriously affect claims payment if not completed properly.

Box 12 is the release of information box. Many think that if you don’t have to release any information that you can just leave this blank. Others think you just stick “signature on file” there and you’re good. Well, neither are correct. Many carriers will not release payment if this box is not completed. But just sticking “signature on file” in there is not correct either. You really need to know that the patient’s signature is on file with the provider you are billing for. The patient should have signed a release of information statement when they first came in. It is usually part of the initial paperwork that they complete. If you are a billing service, you should ask your providers when you are setting up to do the billing if they have these statements on file for all patients so that you can indicate signature on file on all claims. In any case, this is an important box that you need to pay attention to.

Box 13 is the authorization of payment of medical benefits to the provider of service. If this box is completed then the patient is indicating that they want any payments for the services being billed to be sent directly to the provider. This doesn’t guarantee that the insurance carrier will send payment to the provider, but it indicates that they patient gives them permission to. For example, if the provider is not in network the insurance carrier may send payment directly to the patient even if this box is completed. And, if the provider is in network, but this box is not completed it is possible that payment could go to the patient. So again, if you have the patient’s authorization for payment to be made to the provider, you should make sure this box is completed.

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Source by Michele Redmond

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