Home Health & Hospice Week

You'd better make sure you're submitting the right CMS 1500 form or face payment delays.

The Centers for Medicare & Medicaid Services granted suppliers, therapists and other providers that use the 1500 claim form a respite and will allow the old version (12-90) until around June 1, not April 1 as originally planned (see Eli's HCW, Vol. XVI, No. 10). The revised version (08-05) accommodates the National Provider Identifier (NPI) number.

The delay will give everyone, including providers, clearinghouses and vendors, more time to comply with the new form, cheers Cyndee Weston, executive director of the American Medical Billing Association. "I am doubtful that some software vendors would have been ready by April 1," she adds. Many of them will welcome the delay.

Also, some carriers might not have been ready to accept the new form, notes Gary Lindsay with Lindsay Technical Consultants in Mankato, MN.

The problem: Print vendors, specifically the Government Printing Office (GPO), sold incorrectly formatted versions of the revised form, notes Brian Reitz, CMS health insurance specialist, in a March 9 Medicare notice.

Submitting incorrect versions of the revised form will delay your payments. Your carrier won't key in a claim using an incorrectly formatted version and will instead return it to you.

To find out if your CMS-1500 version 08-05 is in danger of bouncing back, look at the upper right-hand corner of the form. Properly formatted claim forms contain approximately a one-quarter inch gap between the tip of the red arrow above the vertically stacked word "CARRIER" and the top edge of the paper. "If the tip of the red arrow is touching or close to touching the top edge of the paper, then the form is not printed to specifications," Reitz concludes.

To tell the difference between the old form and new form, look at the approval numbers, advises attorney Jim Pyles with Powers Pyles Sutter & Verville in Washington, DC. The old form has this identifying number near the bottom: Approved OMB-0938-0008 FORM CMS-1500 (12-90). The new form has this number: Approved OMB-0938-0999 FORM CMS-1500 (08-05).

Even with the delay, the new form will have problems, Lindsay notes. There's no space to list the secondary carrier, which all primary carriers require. Physical therapists must list the date of the patient's last X-ray, but there's no space for it. And finally, the carrier's name and address are in the top right-hand corner, which means you can't use a windowed envelope--because the stamp should go in the upper right-hand corner.

Unresolved issue: "We don't exactly know how the claim form delay will play out with the NPI deadline in May," notes Weston. "It shouldn't be an issue for electronic transactions. But with paper claims, use of old forms without the NPI after the NPI deadline could become an issue." (See related story on the NPI deadline extension, p. 82.)