What You Should Know about the DME Claim Form HCFA 1500

The DME claim form HCFA 1500 allows any healthcare provider (including DME suppliers) to submit claims for reimbursement from government insurance plans, including Medicare and Medicaid. Then the Health Care Financing Administration reviews the claims to determine if it meets the requirements for payment. 

This article will provide you with detailed information about this DME claim form, how to complete it, and some commonly asked questions from DME providers.  

What is the HCFA 1500 DME Claim Form?

The HCFA 1500 form is also known as the CMS-1500 form (Health Insurance Claim Form). It’s the standard health insurance document for individual provider claims who need to submit charges under Medicare Part B. Due to federal regulations, this is the standard form for filing claims to any government insurance plan. Any form updates are completed by the National Uniform Claim Committee (NUCC).

Ordering a Form 

Although this form is from the Centers for Medicare and Medicaid Service (CMS), they can’t supply healthcare providers with the paperwork. To purchase a printed or electronic version, you will need to call the U.S. Government Printing Office at 202-512-1800. You can learn more about ordering this form on the CMS website.

Another option is to order the forms from Amazon. If you choose to order from  Amazon, you’ll need to ensure that it’s the correct version and it’s accurate. To be safe, you can contact the U.S. Government Printing Office to learn precisely the form you need. 

HCFA 1500 Form Instructions

Below is a general overview of how to compete for the form. Click here for detailed information on completing the DME claim form HCFA 1500.

The main components you’ll need to complete for the HCFA 1500 form include the following. 

  • Type of payer 
  • Patient information
  • Insurance information
  • Indicate if the product is reserved for local use (applies to Medicaid) 
  • Referring physician’s NPI information
  • Medical Codes
  • Federal Tax ID
  • Include the total cost of the order 
  • The payer’s NPI’s information 

It’s important to note that if this is a resubmission, make sure to include the Medicare resubmission code (the original reference number of the first claim).

Commonly Asked Questions about the HCFA 1500 Form

Although the DME claim form may appear straightforward, it requires attention to detail and a skilled biller to complete. As a result, there are many questions regarding the HCFA 1500 claim form. Here are some of the most asked questions.

Does the HCFA 1500 have any other names?

  • CMS-1500 Form
  • AMA (American Medical Association) Form

What to expect after claim submission? 

After you submit the claim, it’s sent to a Medicare contractor who will perform a series of edits. These multiple edit rounds will determine if the claims meet the basic requirements of the HIPAA standard. If there are any errors, the claim will need to be resubmitted. If there are no errors, the contractor will generate an acknowledgment report and send it to you.

For more details on this process, visit the CMS website. 

What’s the difference between HCFA 1500 and UB-04?

Although these two forms look similar, you can’t use them interchangeably. Any healthcare provider can use the HCFA 1500 for reimbursement from a government program. In contrast, the UB-04 can only be used by institutional facilities for surgery, radiology, or laboratory services.

Can I complete a paper copy of the form?

Yes, you can use a paper copy, but there are strict guidelines for acceptable use. Review the CMS website for additional information on printed forms. 

Do all HCFA 1500 submissions require a narrative or attachment?

Yes, whether you submit the form through a clearinghouse or directly to the Board, you’ll need to include a medical narrative or attachment.

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As one of the top DME billing companies in the United States, our team specializes in DME billing solutions to help you achieve your goals. Our services include document review, claims management, A/R collection, and more. 

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