Boxes 12 & 13 on the CMS 1500 form are very important but are often overlooked. By overlooked, I mean that most medical billers don’t understand the importance of the boxes and just blindly fill them in.
It is important to understand what these fields ask for and to make sure they have been filled in appropriately because they can seriously affect claims payment if not completed properly.
Box 12 is the “release of information” box. Many billers think that if you don’t have to release any information, you can just leave this blank. Others think you just stick “signature on file” there and you’re good. Well, neither is correct.
Many carriers will not release payment if this box is empty. But just sticking “signature on file” in there is not correct either. You really need to know that the patient’s signature is on file.
The patient should have signed a release of information statement when he or she first came in. It is usually part of the initial paperwork that he or she completes. In any case, this is an important box that you need to pay attention to, so you’ll want to make sure this statement is completed by patients when they first come into your office.
Box 13 is the “authorization of payment of medical benefits to the provider of service.” If this box is completed, the patient is indicating that they want any payments for the services being billed to be sent directly to the provider. This doesn’t guarantee that the insurance carrier will send payment to the provider, but it indicates that the patient gives them permission to do so.
For example, if the provider is not in-network, the insurance carrier may send payment directly to the patient – even if this box is completed. And, if the provider is in-network but this box is not completed, it is possible that payment could go to the patient. So again, if you have the patient’s authorization for the payment to be made to the provider, you should make sure this box is completed to help ensure that you receive payment for services from the payer.
What issues have you encountered on the CMS 1500 form?
Alice Scott and Michele Redmond are medical billing experts, co-owners of Solutions Medical Billing Inc in Rome, N Y., and coauthors of 15 books on medical billing and medical credentialing. Their newest title is Advanced Medical Billing Marketing for the New Economy.
This mother-and-daughter team maintains two medical billing websites, a free newsletter, and an active forum. Alice and Michele are on the editorial staff of BC Advantage and are regular contributors to the magazine. Their books are available at www.medicalbillinglive.com.
