• The HCFA form is what non-institutional practitioners use to bill insurance companies for services provided.
• The HCFA form comprises medical billing codes and the patient’s demographic and insurance information.
• To file an HCFA form, fill in all 33 boxes and run your form through a claim scrubber to identify errors.
• This article is for medical practitioners and billers looking to understand the forms used to file medical claims.

Since 92% of Americans have health insurance, medical billing is inevitably part of a practice’s everyday tasks. Sure, most practitioners didn’t get into medicine to file paperwork all day, but the HCFA form – the primary medical claim form – is relatively easy to complete. This guide will tell you all about the form and how to fill out and file it.

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What is the HCFA form?

The HCFA form, also known as Form HCFA 1500 or Form CMS-1500, is what non-institutional practitioners file to payers (insurance companies). They often comprise the basis of medical claims.

The abbreviation “HCFA” stands for “Health Care Finance Administration.” As you might guess from this name, the HCFA 1500 has official origins. It’s the work of the Centers for Medicare & Medicaid Services (CMS), which initially devised it to facilitate Medicare and Medicaid reimbursements. 

Form HCFA is so comprehensive that private insurers have also adopted it as their standard. Additionally, federal law requires practitioners seeking reimbursement to file either these forms or UB-04 forms, which we’ll explain later in this article.

How does the HCFA form work?

Practitioners like yourself (or, more realistically, your front-office staff or third-party medical billing team) will complete the HCFA form after a patient encounter. A complete HCFA form will include Current Procedural Terminology (CPT) codes for all services provided. It may also include International Classification of Diseases, 10th Revision (ICD-10) codes for diagnoses. These codes standardize services, so payers more easily know what to reimburse.

Your HCFA form should also include your patient’s demographics and basic information. Just as importantly, the form should clearly state your patient’s insurance information. This way, payers know exactly which of your CPT and ICD-10 codes they can and can’t reimburse.

Who fills out an HCFA form?

Any of these kinds of individual practitioner can complete and file HCFA forms:

• Physicians
• Specialists
• Nurse practitioners
• Nurse-midwives
• Certified nurse anesthetic practitioners
• Physician assistants
• Clinical psychologists
• Clinical social workers
• Ambulance services
• Laboratory services

FYI: Only non-institutional healthcare providers should fill out the HCFA form. Other providers must use Form UB-04.

What is included in an HCFA form?

The HCFA form is made up of 33 boxes. If that seems like an overwhelming number, fret not – each box requires little information, most of which is rudimentary. Plus, we’ve prepared the following billing guide to HCFA so you can breeze through the process. Each numbered entry in this guide corresponds to the same box number on the HCFA form.

1. Insurance information: Indicate Medicaid, Medicare or the patient’s private insurer alongside their insurance ID, which goes in box 1a.
2. Patient’s name: Write the patient’s full legal name.
3. Patient’s sex and date of birth: Write the month, date and year as two digits each. Check the appropriate box for the patient’s sex assigned at birth.
4. Insured’s name: If the patient is using their own insurance plan, you can leave this box blank. If their plan is in someone else’s name, write that name here.
5. Patient’s address and phone number: Fill out each box in this section with the appropriate information. 
6. Patient’s relationship to insured: Check the appropriate box. You should only check one of the four boxes present.
7. Insured’s address: Again, leave this box blank if the patient is self-insured. Otherwise, add this information for the person whose name is on the insurance plan.
8. Patient status: Check one box in the first row (marital status) and one box in the second row (employment status).
9. Other insurance information: Leave this section blank if the patient has only the primary insurance indicated earlier on the form. If the patient has secondary insurance, include all requested information here.
10. Patient condition and Medicaid information: Here, indicate whether the services you provided were in response to injuries or illnesses sustained on the job, in a car accident or in another kind of accident. In the “reserved for local use” box, add the patient’s Medicaid number if they have one.
11. Insured’s policy or group number: Here, write down the patient’s policy, group or FECA number. You should also include the identifying information requested. If you’ve added information to box 9, check “yes” in box 11d.
12. Patient’s signature: All HCFA forms require a patient’s signature to submit. This box is where you’ll record that signature. 
13. Insured’s signature: You only need to complete this section if the patient has secondary insurance, as indicated in box 9.
14. Date of condition being treated: Write the date when the patient first began experiencing symptoms.
15. Previous reports of condition being treated: If the date of the patient encounter you’re billing for isn’t the patient’s first instance of this condition, record the first date here instead. You should write the date of the encounter you’re billing for if this is indeed the patient’s first time with symptoms.
16. Dates out of work: If the patient’s condition has put them out of work, include the dates the patient has been sidelined.
17. Referring provider: If another practitioner referred the patient to you, list that practitioner’s name, ID number and National Provider Identifier (NPI).
18. Hospitalization dates: If the patient’s condition has led to their hospitalization, list the hospitalization dates here.
19. Reserved for local use: Leave this section blank for the recipient of the form should they need it. 
20. Outside lab charges: If you’re filing a claim for third-party lab tests, check the “yes” box and write down the charge amount.
21. CPT codes: List the CPT codes corresponding to the services provided. You can use the page-width lines under “Diagnosis Pointer” to provide additional codes.
22. Medicaid resubmission code: If you’re resubmitting a rejected claim to Medicaid, write the original claim’s reference number here.
23. Prior authorization number: If your patient brought prior authorization from the payer to their appointment, add the authorization number here. You’ll also need a seven-digit IDE number for investigational devices and a ZIP code for ambulance services.
24. Service details: Here, you’ll list the dates and location of service, the services provided, and the corresponding charge amounts. You’ll also complete the diagnosis pointer section you first encountered in box 21. Note that you can leave this box blank for influenza or pneumococcal vaccines.
25. Tax identifier: Provide your employer identification number (EIN) or, if you’re a sole practitioner with no EIN, your Social Security number.
26. Patient account number: Though completing this box is optional, writing your patient’s account number within your practice can help you link the claim with the patient and track progress accordingly.
27. Accept assignment: Check the “yes” box for physician, laboratory, surgical, supplier or ambulance services.
28. Total charges: Write the total amount of reimbursement you’re seeking.
29. Amount paid: If part of the claim has already been paid, indicate that amount here.
30. Balance due: Subtract the value in box 29 from box 28, then write that amount here.
31. Provider signature: Sign your HCFA form here.
32. Service facility location information: Write the full address of the location where services were provided.
33. Service provider information: Here, list your address again alongside your NPI and phone number. You’re now done with your HCFA form.

How to file an HCFA form

Once you’ve completed your form, you should run it through a claim scrubber to check for any errors. These tools are usually available through third-party medical billing service providers. Once you fix the indicated errors, you can resubmit your HCFA form to an appropriate clearinghouse, which will deliver it to the appropriate payer.

Tip: Run your HCFA form through a claim scrubber to identify errors that could result in claim rejections.

What is the difference between UB-04 and HCFA?

Whereas individual, non-institutional practitioners file HCFA forms, institutional practitioners submit Form UB-04. This distinction means that hospitals, inpatient facilities, nursing facilities, and other medical facilities use Form UB-04. All other practitioners use Form HCFA instead.

This boundary between Form UB-04 and HCFA is admittedly a bit vague. However, medical billing experts completely understand the difference. Better yet, the medical billing experts who work at third-party medical billing companies (see our AdvancedMD review for an example) can complete and file these forms on your behalf. 

If you’d prefer to avoid the headache of choosing the right forms and spending time on paperwork, visit our medical billing best picks page. There, you’ll find our recommendations for third-party medical billing services based on your practice size, specialty, billing complexity and other factors. The medical billing process can be tedious, but with outsourced medical billing, it becomes significantly easier.

© Provided by The Financial Express Virtual treatment and data collection were critical during the COVID-19 epidemic, when both patients and clinicians were unable to visit hospitals in the traditional sense. (File)

By Hari Subramaniam

Virtual treatment and data collection were critical during the COVID-19 epidemic, when both patients and clinicians were unable to visit hospitals in the traditional sense.

The lively startup culture in India, as well as urban adoption of cutting-edge technologies like cloud computing and artificial intelligence, have fueled the expansion of health technology businesses in the country (AI). These inventive enterprises Boost medical treatments by combining tried-and-true practices with these state of the art technology. Telemedicine and Internet-delivered healthcare services are helping these companies flourish in India.

A digitally transformed, intelligent healthcare system delivers a unified, patient-centred experience that improves patient outcomes, increases productivity and revenue, and reduces environmental impact. Our healthcare system must do more with less resources, which may be achieved by investing in smart infrastructure and using technology.

Because they supply new ways to connect and share data, as well as operational benefits, the Internet of Things (IoT) and artificial intelligence (AI) have become widespread forces in business. It’s a brilliant idea for medicine, where the Internet of Things (IoT) and Remote Patient Monitoring (RPM) are colliding to transform the fundamental concept of care. The development of reliable biosensors promises to revolutionise healthcare and the way people live in the future by providing more information about their health. Remote patient monitoring assists clinicians by improving clinical knowledge of patients’ state between office visits and providing tools to promote proactive care delivery. A practitioner may use RPM to observe how a patient’s symptoms vary over time, enabling them to discover patterns and adjust the patient’s treatment as needed.

The cost of providing treatment to a patient online is cheaper than the cost of providing care in a traditional setting. When a corporation applies RPM, net patient revenue may increase as a consequence of increased process efficiency, increased employee productivity, and lower administrative expenses. RPM also allows for remuneration and a competitive edge.

Patients may get treatment regardless of their location or time of day with the help of remote patient monitoring. It allows patients in remote locations to be connected with the relevant expertise. It’s also a great way to cut down on appointment no-shows.

The use of remote patient monitoring, which provides doctors with near real-time status information, allows them to more efficiently prioritize treatment delivery. To save paperwork, certain RPM technologies may interface with the provider’s electronic medical record. By enabling physicians to conduct a part of treatment online, RPM may help alleviate the pressure of overbooked in-person sessions in the face of severe staffing shortages. A provider-friendly approach to team-based care is required.

This technology also contributes to the prevention of disease transmission. Patients may avoid potentially infectious hospital and clinic situations by utilising RPM. Those at higher risk of infection, such as the elderly, chronically sick people, pregnant women, and those with impaired immune systems, are protected from this risk by avoiding direct contact with others.

Remote monitoring allows for the detection of complexity and changes occurring in real time with the patient and for action to be taken at the proper time to save the patient. To accomplish so, healthcare organizations must have the necessary resources, experience, and cutting-edge technology.

Remote patient monitoring benefits both doctors and patients by expanding communication options, therefore strengthening the patient-provider bond and improving patient loyalty. It provides patients with the comforting idea that their doctor is always monitoring them, making RPM a clear and consistent winner for patients, caregivers, providers, and prayers throughout the industry.

(The author is a Founder & Director, LifeSigns. The article is for informational purposes only. Please consult medical experts and health professionals before starting any therapy, medication and/or remedy. Views expressed are personal and do not reflect the official position or policy of the FinancialExpress.com.)

With dispensaries opening across Mississippi, the state’s medical cannabis program is now in full swing. But there are still some bumps in the road.Medical marijuana may not be a cure-all, but it could bring relief to thousands of Mississippians suffering from diseases that cause chronic pain."I really noticed since I’ve been medicating, just with this medical cannabis in Mississippi, I mean, my life quality has really, really improved," said cannabis patient Joshua Gee.People who suffer from more than two dozen qualifying conditions now have access to the state’s new medical cannabis program."I’m grateful to the legislature for getting this, you know, up and going and available to us patients," said cannabis patient Stephanie Gray.But some patients are having a hard time finding help."At the end of January, we had over 10,000 patients searching our website for information about medical cannabis cards, practitioners and dispensaries," said Angie Calhoun, with the Mississippi Cannabis Patients Alliance.Calhoun said there are more than 100 practitioners across the state, but it’s not easy for patients to find one of those practitioners."What we need is our practitioners to really promote themselves," Calhoun said. "Because most of our patients think that any practitioner can certify them for medical cannabis, and that’s just not the case."According to state law, a medical practitioner must first take an eight-hour course and get certified by the Mississippi State Department of Health. Only then can they issue a written certification to a patient who wants a cannabis card.Another big drawback is cost."I’m getting a lot of emails from patients saying the prices are really too high for them to afford," Calhoun said.Patients like Gee, who was diagnosed with PTSD years ago after serving in the Iraq war."I have three different types of insurance and I still have to pay out of pocket," Gee said.Neither private insurance nor Medicaid or Medicare will pay for medical cannabis. Calhoun said dispensaries are charging anywhere from $35 to $65 for a single unit."And so, when we break this down, we're looking at, you know, on the higher end that's $30 a day for a person to use medical cannabis, which, you know, that comes up to over $1,500 a month," Calhoun said."And that's absurd. I mean, we're talking about people with disabilities that are so detrimental to their daily life and the bad things they may experience that they can't work. So, I honestly don't know how people are going to be able to afford it at that price," Gee said.Calhoun worries desperate patients who can’t afford cannabis could go to the street looking for illicit marijuana, and that could be a health risk."I’m going to encourage our dispensaries and our brands, 'Please, let’s work together to find a way to lower the price for our patients,'" Calhoun said.Some believe prices could drop when large out-of-state companies open more dispensaries in Mississippi.

A nurse practitioner employed by the Chatham County Detention Center’s private healthcare provider, Correct Health, was arrested Friday for stealing a former inmate’s prescription medications.

According to a Chatham County Sheriff's Office news release, the CCSO K9 Unit conducted a free air sniff of the employee parking area at approximately 8:30 a.m. on Friday, during which Deputy K9 Petra gave a positive (sit) on a white Lexus SUV owned by Quyen Nguyen. Nguyen was employed as a nurse practitioner with Correct Health, the private medical company contracted for health care services at the Chatham County jail.

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After an explanation of procedures, CCDC employees searched Nguyen’s vehicle, during which a former inmate’s prescription medications were found. Nguyen was arrested and booked into the Chatham County Detention Center for theft by taking, interference with government property-theft of government property, and theft of medical products.

Sheriff John Wilcher was quoted in the press release, “The implementation of these types of security protocols ensures the safety and wellbeing of the CCSO staff, inmates and our community. I have zero tolerance for this type of criminal activity.”

CCSO's public information officer Parla Parker said she did not have any more information than provided in the press release, including the inmate and the type of prescriptions Nguyen allegedly stole. It is unclear whether CCSO staff were tipped off or had suspicions about Nguyen, or if these types of inspections occur regularly.

Questions about Nguyen’s employment history were directed to Shawn Wood, health services administrator for Correct Health. Wood has not yet responded.

This is a developing story.

Drew Favakeh is the public safety reporter for Savannah Morning News. You can reach him at AFavakeh@savannahnow.com.

This is a developing story.

This article originally appeared on Savannah Morning News: Chatham County jail nurse arrested for stealing former inmate's medication

By Hari Subramaniam

Virtual treatment and data collection were critical during the COVID-19 epidemic, when both patients and clinicians were unable to visit hospitals in the traditional sense.

The lively startup culture in India, as well as urban adoption of cutting-edge technologies like cloud computing and artificial intelligence, have fueled the expansion of health technology businesses in the country (AI). These inventive enterprises Boost medical treatments by combining tried-and-true practices with these state of the art technology. Telemedicine and Internet-delivered healthcare services are helping these companies flourish in India.

A digitally transformed, intelligent healthcare system delivers a unified, patient-centred experience that improves patient outcomes, increases productivity and revenue, and reduces environmental impact. Our healthcare system must do more with less resources, which may be achieved by investing in smart infrastructure and using technology.

Because they supply new ways to connect and share data, as well as operational benefits, the Internet of Things (IoT) and artificial intelligence (AI) have become widespread forces in business. It’s a brilliant idea for medicine, where the Internet of Things (IoT) and Remote Patient Monitoring (RPM) are colliding to transform the fundamental concept of care. The development of reliable biosensors promises to revolutionise healthcare and the way people live in the future by providing more information about their health. Remote patient monitoring assists clinicians by improving clinical knowledge of patients’ state between office visits and providing tools to promote proactive care delivery. A practitioner may use RPM to observe how a patient’s symptoms vary over time, enabling them to discover patterns and adjust the patient’s treatment as needed.

The cost of providing treatment to a patient online is cheaper than the cost of providing care in a traditional setting. When a corporation applies RPM, net patient revenue may increase as a consequence of increased process efficiency, increased employee productivity, and lower administrative expenses. RPM also allows for remuneration and a competitive edge.

Patients may get treatment regardless of their location or time of day with the help of remote patient monitoring. It allows patients in remote locations to be connected with the relevant expertise. It’s also a great way to cut down on appointment no-shows.

The use of remote patient monitoring, which provides doctors with near real-time status information, allows them to more efficiently prioritize treatment delivery. To save paperwork, certain RPM technologies may interface with the provider’s electronic medical record. By enabling physicians to conduct a part of treatment online, RPM may help alleviate the pressure of overbooked in-person sessions in the face of severe staffing shortages. A provider-friendly approach to team-based care is required.

This technology also contributes to the prevention of disease transmission. Patients may avoid potentially infectious hospital and clinic situations by utilising RPM. Those at higher risk of infection, such as the elderly, chronically sick people, pregnant women, and those with impaired immune systems, are protected from this risk by avoiding direct contact with others.

Remote monitoring allows for the detection of complexity and changes occurring in real time with the patient and for action to be taken at the proper time to save the patient. To accomplish so, healthcare organizations must have the necessary resources, experience, and cutting-edge technology.

Remote patient monitoring benefits both doctors and patients by expanding communication options, therefore strengthening the patient-provider bond and improving patient loyalty. It provides patients with the comforting idea that their doctor is always monitoring them, making RPM a clear and consistent winner for patients, caregivers, providers, and prayers throughout the industry.

(The author is a Founder & Director, LifeSigns. The article is for informational purposes only. Please consult medical experts and health professionals before starting any therapy, medication and/or remedy. Views expressed are personal and do not reflect the official position or policy of the FinancialExpress.com.)