How to Fill Out and File an HCFA Form

The HCFA form is what non-institutional practitioners use to bill insurance companies for services provided. Here’s how to complete and file it.

Non-institutional practitioners charge insurance companies for the services they offer using the HCFA form.
The HCFA form includes the patient’s demographic and insurance details as well as medical billing codes.
When submitting an HCFA form, be sure to complete all 33 boxes and run your form through a claim scrubber to check for mistakes.
Medical professionals and billers who want to comprehend the forms used to submit medical claims should read this article.

Medical billing is unavoidably a part of a practice’s daily operations since 92% of Americans have health insurance. Even though the majority of practitioners didn’t choose the field of medicine to spend their days filling out paperwork, the main medical claim form, the HCFA, is not too difficult to complete. This manual will explain the form in detail and show you how to complete and submit it.

What is the HCFA form?

Non-institutional practitioners submit the HCFA form, also known as Form HCFA 1500 or Form CMS-1500, to payers (insurance companies). They often serve as the foundation for medical claims.

The term “Health Care Finance Administration” is referred to by the acronym “HCFA.” The HCFA 1500 has official beginnings, as one may infer from its name. The Centers for Medicare & Medicaid Services (CMS) created it in order to make Medicare and Medicaid payments easier.

Because of Form HCFA’s extensiveness, private insurers have also chosen it as their benchmark. Moreover, according to federal law, practitioners who want payment must submit either these forms or the UB-04 forms, which we’ll cover later in this piece.

How does the HCFA form work?

The HCFA form will be filled out by practitioners like you (or, most likely, by your front office staff or third-party medical billing team) after a patient interaction. Current Procedural Terminology (CPT) codes for each service rendered are required on an entire HCFA form. ICD-10 codes for diagnoses may also be used, according to the 10th revision of the International Classification of Diseases. By standardising services, these codes make it simpler for payors to determine what to reimburse.

The demographics and fundamental details of your patient should also be included on your HCFA form. The paperwork should explicitly describe your patient’s insurance details, which is equally crucial. Payers will know precisely which CPT and ICD-10 codes they can and cannot reimburse as a result.

Who fills out an HCFA form?

Any of these kinds of individual practitioner can complete and file HCFA forms:

A.Physicians

B.Specialists

C.Nurse practitioners

D.Nurse-midwives

E.Certified nurse anesthetic practitioners

F.Physician assistants

G.Clinical psychologists

H.Clinical social workers

I.Ambulance services

J.Laboratory services

What is included in an HCFA form?

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.

• A. The name and address of your supplementary insurance provider are shown in the top left-hand corner of your HCFA 1500 claim form. Attach copies of your Explanation of Medicare Benefits documents to your HCFA 1500 claim forms as soon as you get them. Send them via mail to the following address and name.
  B. Verify the correctness of the insured person’s identity number in Box 1A of this form. Please get in touch with the Mayo Clinic’s Patient Account Services at 507-266-5670 if this number differs from what is on file for you.
  C. Box 11 of this form contains a list of the insurance group number for the covered individual. Please make sure this number is accurate. Please enter your insurance group number in this box if it’s empty and you have one.
  D. You will notice the words “Signature on File” in Box 12. You have now granted Mayo Clinic permission to disclose the medical data required to submit your insurance claim.
  E. The words “Signature on File” in Box 13 indicate that Mayo Clinic has been given permission to receive payment for medical benefits. If the box is empty, Mayo Clinic does not have your permission to allocate payment of your medical benefits.
  F. The dates of your hospitalisation are noted in Box 18 if you were treated at Rochester Methodist Hospital or Saint Marys Hospital.
  G. Please confirm that all costs have been handled by Medicare. Compare each line on your Explanation of Medicare Benefits papers with the date(s) of service (Box 24A), description of service (Box 24D), and fee for the service (Box 24F) to confirm costs.
  H. Your claim number is the number in Box 26.
  I. The assignment indication is located in Box 27 of this form.
  If “Yes” is checked in this box, Mayo Clinic anticipates receiving payment from your supplementary insurance provider. It does not follow that Mayo will consider the insurance payment to be complete payment. Copays, deductibles, excluded goods, and normal and customary allowances are your responsibility.
  If this box is checked, Mayo Clinic anticipates receiving benefits from your insurance carrier on your behalf.
  J. The total fees on that page of the HCFA 1500 are shown in Box 28. To get your total costs for your visit to the Mayo Clinic, sum the amount from each page of your claim if it contains several pages.

 

How to file an HCFA form

After you’ve finished filling out your form, you should verify it for mistakes by running it through a claim scrubber. Typically, third-party medical billing service companies provide these options. Once the mistakes have been corrected, you may submit your HCFA form again to the proper clearinghouse, which will then send it on to the proper payer.

What is the difference between UB-04 and HCFA?

Institutional practitioners submit Form UB-04, while lone, non-institutional practitioners submit HCFA forms. Because of this difference, Form UB-04 is used by hospitals, inpatient institutions, nursing homes, and other healthcare facilities. Every other practitioner makes use of Form HCFA.

It is true that the distinction between Form UB-04 and HCFA is a little hazy. Experts in medical billing, however, are well aware of the distinction. Even better, these papers may be filled out and submitted on your behalf by the medical billing specialists who work for independent third-party medical billing organisations (see our AdvancedMD review for an example).

Visit our list of the top medical billing services if you’d rather not deal with the hassle of selecting the appropriate papers and devoting time to paperwork. You may discover there our suggestions for third-party medical billing services depending on the size, specialisation, billing complexity, and other characteristics of your business. Although the medical billing process might be laborious, it is much simplified when it is outsourced.