Tips for Successful Paper Billing

Medical billing is often done through electronic claims processing, but paper billing is still necessary for some claims. Paper billing isn't the first choice as it takes longer and requires more attention to detail as errors won't be flagged by the software as in electronic billing. Here are tips for manual medical claim processing.

Use the Correct Form: CMS-1500 or UB-04

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It is important to understand and use the standard medical claim form. Choose between the CMS-1500 and the UB-04 claim forms.

CMS-1500: This is the red ink on white paper standard claim form used by physicians and suppliers for claim billing. Any non-institutional provider and supplier can use the CMS-1500 for billing medical claims.

  • Physician services
  • Physician assistants
  • Nurse practitioners
  • Clinical nurse specialists
  • Nurse midwives
  • Certified registered nurse anesthetists
  • Clinical psychologists
  • Clinical social workers
  • Home dialysis supplies and equipment
  • Ambulance services
  • Clinical diagnostic laboratory services

UB-04: This is the red ink on white paper standard claim form used by institutional providers for claim billing. Any institutional provider can use the UB-04 for billing medical claims.

  • Community Mental Health Center
  • Comprehensive Outpatient Rehabilitation Facility
  • Critical Access Hospital
  • End-Stage Renal Disease Facility
  • Federally Qualified Health Center
  • Histocompatibility Laboratory
  • Home Health Agency
  • Hospice
  • Hospital
  • Indian Health Services Facility
  • Organ Procurement Organization
  • Outpatient Physical Therapy Services
  • Occupational Therapy Services
  • Speech Pathology Services
  • Religious Non-Medical Health Care Institution
  • Rural Health Clinic
  • Skilled Nursing Facility

Make Sure the Format Is Correct

Some payers accept the photocopied black-and-white versions of the medical claims, but the best process is to submit the original red-and-white version. Depending on the payer, when the original claim form is not used, the claim may not scan into their system properly creating a delay or denial in payment.

  • Make sure the printer is lined properly to ensure that the information is printed in the correct field locations.
  • Do not highlight any information on the claim.
  • Do not handwrite comments on the form such as "Corrected Claim" or "EOB Attached."
  • Do not attach staples, stamps, tapes, sticky notes, paper clip or anything else to the claim forms.

Enter Accurate Data in the Correct Location on the Form

  • Check with each insurance payer to determine what data is required.
  • Ensure that all data is entered correctly and accurately in the correct fields.
  • For UB-04: Most instructions for inpatient and outpatient services are the same. See the Uniform Billing Guide for specific details.
  • Enter insurance information including the patient's name exactly as it appears on the insurance card.
  • Use correct diagnosis codes (ICD-10) and procedure codes (CPT/HCPCS) using modifiers when required.
  • Use only the physical address for the service facility location field.
  • Don't forget to include NPI information where indicated.

Include Proper Documentation

Sometimes paper billing requires proper documentation to be mailed with the claim form.

  • Itemized statement
  • Medical history or medical records
  • Primary payer explanation of benefits
  • Proof of accident, injury, or incident

File a Clean Claim

A clean claim is one that is accurately completed in accordance with the insurance companies and federal government's billing guidelines. Since billers are the last hands that touch a medical claim, they are responsible for making sure that it goes out clean. Submitting a clean claim is the only way to guarantee correct payment the first time.

Medical office managers can do their part in making the biller's job a little easier in several ways.

  1. Purchasing real-time benefits verification software can save precious time by verifying a patient's insurance information at check-in time.
  2. Upgrade your old paper-based medical record system to the electronic health record (EHR).
  3. Keep the billing software pre-billing claim checks up-to-date with health care industry changes for billing, coding, and information specific to certain payers allowing staff to make proper corrections.
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