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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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.
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.
Any of these kinds of individual practitioner can complete and file HCFA forms:
FYI: Only non-institutional healthcare providers should fill out the HCFA form. Other providers must use Form UB-04.
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.
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.
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.
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.)
A medical practitioner, Dr Richard Okoye, has urged Nigerians in the diaspora to desist from demarketing the country by painting it in a bad light.
Okoye, who is the founder and chairman of Savealife Mission Hospital in Port Harcourt, the Rivers State capital, was reacting to a accurate viral video of a young diasporan who claimed the Nigerian healthcare system was completely dead.
The young man, who claimed to be a healthcare practitioner in the UK, also added that the Nigerian healthcare system only detects only three viruses.
Reacting, Dr Okoye warned the young diasporan and others of his ilk to stop posting misleading health information about Nigeria’s healthcare system.
According to him, such acts would only serve to demarket the country.
Dr Okoye admitted that the Nigerian healthcare system is suffering but said the picture is not as grim as painted by the fellow.
He said, “It is time to stop this. You are not the only person that started travelling. You are not the only person that is outside the country. If you discover anything that is not working in Nigeria and it is working elsewhere, pick it up and bring it home.”
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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.
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
This week's ABC Four Corners investigation revealed the Australian Health Practitioner Regulation Agency (Ahpra), or tribunals determining such complaints, allowed a number of doctors sanctioned for sexual misconduct to resume practising.
The ABC suggests almost 500 practitioners from a range of health professions, many of whom are doctors, have come to Ahpra's attention for“boundary violations” since 2010. Boundary violations is the generic term for health practitioner sexual behaviour problems, the most serious of which is sexual assault of a patient.
According to the ABC, about one-third of the 500 practitioners remain registered with Ahpra or have been returned to the register.
Health Minister Mark Butler has ordered a rapid review of whether recommendations from previous reviews have been properly implemented. He told the abc :
So what is the framework? What reforms have been recommended previously? And what needs to happen now to protect patients?
Read more: who is our health regulator, ahpra, and does it operate effectively?
Breaching doctors' code of conductThe Medical Board of Australia, which governs doctors, has a code of conduct . It tells doctors that good medical practice involves never using your professional position to establish or pursue a sexual, exploitative or other inappropriate relationship with anybody under your care. This includes those close to the patient, such as their carer, guardian, spouse or the parent of a child patient.
Even if a patient consents to sexual contact, the power imbalance between the patient and the health professional nevertheless means the sexual contact is probably inappropriate. More detail appears in guidelines specific to sexual boundaries between doctors and patients.
Similar ethical guidance appears in the united kindom and new zealand .
Mandatory reporting rules mean health professionals have an obligation to report sexual misconduct by their peers, generally to Ahpra. Failure to do so may itself be unsatisfactory professional conduct.
Of course, a patient may make a direct complaint of sexual misconduct to Ahpra or to local health-care complaints organisations.
Immediate action can be taken by Ahpra (or other bodies in New South Wales and Queensland) pending proceedings being brought against health practitioners in various tribunals across Australia.
Those proceedings will determine if a boundary violation occurred and provide for an appropriate response, which may prevent the health practitioner from practising or may impose lesser constraints, such as mentoring or education.
Read more: rape, sexual assault and sexual harassment: what's the difference?
Patients may also report sexual assault (or other offences such as possession of child abuse materials) to the police, which may lead to criminal prosecution and possible imprisonment. Convicted health practitioners may then not be able to obtain clearance for working with children , making it very difficult if not impossible to continue work as a doctor or other health practitioner.
Patients suffering injury (usually mental harm) can seek compensation by suing the health practitioner and, in some cases, their hospital or clinic.
Patients rarely sue Ahpra for failing to take prompt and appropriate regulatory steps. There is perhaps only one reported case involving Ahpra, which settled before a hearing.
What's going wrong?Incidents of health professionals sexually assaulting patients are of course deeply concerning. But whether anything is“going wrong” with the current regulatory system may be debated.
Patients in different states have access to different information about health practitioners – this could be improved. Patients and doctors have also reportedly complained that the processes of Ahpra, the tribunals or the courts can take“too long”.
Whether permitting some health practitioners to return to practice after boundary violations is appropriate requires careful scrutiny of the history of the complaint.
And as mentioned in the ABC program, health practitioners, patients and Ahrpa could well benefit from more research about what is and is not working to protect patients.
How can we better protect patients?Ahpra, which only come into existence in 2010, has taken steps to Boost how it responds to boundary violation complaints.
In 2016, the Medical Board of Australia and Ahpra commissioned an independent review into the use of chaperones to protect patients. The aim of a chaperone is to have an independent person present to supervise a doctor. Unfortunately the review reported chaperones did not adequately protect patients:
Chaperones are still used today in some circumstances, but probably less often.
A national health practitioner ombudsman has been established to investigate complaints and make recommendations to Boost the regulation of Australia's health practitioners. Its work is probably not well known, but it does publish its reports and submissions.
Ahpra has also recently invited feedback from health practitioners, employers and members of the public on the future uses of the data it collects and stores. It sought views on publishing additional information about health practitioners and their practice on the public register. The feedback process finished only recently, so we do not yet know what the outcome will be.
For boundary violation cases, there may be an argument for more transparency. This would include information about the constraints imposed on health practitioners remaining publicly visible on the Ahpra public register permanently, even if the practitioner's period of suspension, supervision, or the like, eventually lapses.
Read more: a doctor's sexual advances towards a patient are never ok, even if 'consensual'
Perhaps transparency of information is an area for attention more broadly. The ABC reported that only in NSW is information made publicly available when suspended health practitioners apply to return to practice. Arguably, this should be rolled out to the other Australian jurisdictions.
If patient protection cannot be confidently maintained, especially with“repeat offender” health practitioners, we may see calls for a“one strike and you are out” provision. This would mean health practitioners found to have serious or multiple boundary violations may never be permitted to return to practice.
This would be a serious step, but further research on the operation of the current system may assist in assessing the merit of that type of law reform.
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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.)