HS215 - During processing of the encounter form (to generate the claim)

1. During processing of the encounter form (to generate the claim), the billing specialist notices that the provider entered a check mark in front of the procedure, “Hemoccult Stool,” and a check mark in front of the diagnosis, “Gout.” Because medical necessity requires the diagnosis selected to justify the procedure performed, what should the Billing specialist do next?

2. The provider will accept whatever the payer determines is the allowed fee as payment in full.

Should the provider enter a check mark in the YES box for “ACCEPT ASSIGNMENT” on the

CMS1500? What is the ITEM NUMBER(s) of the section of the CMS 1500 form that the patient signs to authorize payment to the provider?

3. Refer to the CMS-1500 claim form (Figure 4-1) on page 62 in your text. Which block on this form would contain an entry based on information contained in the encounter form section “DATE SYMPTOMS APPEARED, INCEPTION OF PREGNANCY, OR ACCIDENT OCCURRED”?