Title: Explain reimbursement forms, including the Centers for Medicare and Medicaid Services (CMS) 1500 and UB-04 forms.
Course: Medical Coding and Billing II (14151-IV) > Section: Introducing Coding Systems

Explanation of forms, including the CMS 1500 and UB-04, should include

- key term
- historical development of CMS reimbursement systems
- special rules for the Medicare physician fee schedule payment system
- chargemaster
- hospital revenue cycle management
- appeal process
- completion of forms for
  - workers’ compensation
  - Blue Cross/Blue Shield
  - Medicare
  - Medicaid
  - TRICARE.

Process/Skill Questions:

- When is a 1500 form used vs. an UB-04 form?
- What are common mistakes made when filling out forms?
- What is a clean claim vs. a dirty claim?
- What are the steps to an appeal?