How To: Create Paper CMS-1500 Claims

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A CMS-1500 form, previously known as a HCFA form, is a paper claim form that users can generate through TherapyNotes, print, and mail to the insurance company for reimbursement. TherapyNotes enables users to print the CMS-1500 content onto a pre-printed red form or to create a PDF that includes the red background to be printed on blank paper. Typically payers require such claims be submitted on pre-printed CMS-1500 forms. Call the payer's paper claims department directly to inquire whether or not they require CMS-1500 claims use the pre-printed red forms, or if you can print out the form from TherapyNotes with the red form lines included. Note that when TherapyNotes generates a CMS-1500 form with the red form lines included, the text on the back of the form is not included. If you are looking for information about superbills and not CMS-1500 forms, see this article.

  • NoteCMS-1500 forms cannot be generated until the corresponding note has been completed and signed.

Here is a thumbnail of a blank CMS-1500 form: 


Printer Settings

First, designate whether your practice will print CMS-1500 forms on pre-printed forms, or if you want to generate the PDF with the red form lines. Click the User Icon > Settings > "Practice Billing" > "Paper Claims" section. Select the appropriate bubble then click the green "Save Billing Settings" button.

For best results printing on pre-printed red forms: Utilize any calibration features offered by the printer, print in a high quality, and use a paper tray (not the fold out tray used for envelopes) which tends to feed in the paper more evenly. If the alignment of the CMS-1500 does not match up with the pre-printed form click the User Icon > Settings > "Practice Billing" > "Paper Claims" section. Adjust the margin offsets and print a few test forms until the content aligns with the boxes.


Set Billing Method to Paper 

The billing method of "Paper" in TherapyNotes enables you to generate CMS-1500 forms or superbills. The method can be set as a default for all in- or out-of-network payers, for a single payer, or per billing line item. 

Set "Paper" for All Payers 

Click the User Icon > Settings > "Practice Billing" > "Preferred Billing Methods" section

Change the dropdown for either in-network or out-of-network payers to "Paper (Print CMS-1500 forms or superbills)".

Click the green "Save Billing Settings" button.

 

Set "Paper" per Payer 

Choose one of the following ways to set all claims for a certain payer to Paper by setting the default at the Payer profile level.

 

Option 1: Click PAYERS > Click payer 

  • Change the "Billing Method" dropdown to "Paper (Print CMS-1500 forms or superbills)", 
  • Click the green "Save Changes" button.

 

Option 2: Click PAYERS > "+Add a Payer"

  • Change the "Billing Method" dropdown to "Paper (Print CMS-1500 forms or superbills)", 
  • Click the green "Save Changes" button.
  • To learn more about adding a new payer profile, read the PAYERS section of this article.

 

Set "Paper" per Billing Line Item 

Click PATIENTS > Click patient > "Patient Billing" tab > Click the date of service

Change the "Method" dropdown to either "Insurance - In Network - Paper" or "Insurance - Out of Network - Paper". 

Click the green "Save Changes" button.


Create CMS-1500 Forms 

There are several ways to create a CMS-1500 form. 

 

Option 1: Click TO DO > "Create CMS-1500 forms"

 

Option 2: Click BILLING > "Create CMS-1500"

This brings you to a list of billing items whose method is set to "Paper" and whose corresponding notes are completed and electronically signed.

 

Option 3: Click PATIENTS > Click patient > "Patient Billing" tab > "Create CMS-1500". This option batches multiple dates of service onto CMS-1500 forms. 

 

Option 4: PAYERS > Click payer > "Payer Billing" tab > "Create CMS-1500"

 

Option 5: Click PATIENTS > Click patient > "Patient Billing" tab > Click date of service > "Create CMS-1500".  This option only includes one date of service on the form. 

 

Option 6: Click PATIENTS > Click patient > "Patient Billing" tab > "Pending Paper" in green. This generates a CMS-1500 for that particular date of service, 

 

Select Dates of Service to Include on the Create CMS-1500 Form Screen

 Either leave the default date range, or enter custom dates. Also, you can select "Pending Items" or "All Items"

 Check off the dates of service to include on the CMS-1500. 

  • Note: TherapyNotes batches up to 6 dates of service per patient onto a single CMS-1500 form.

 From the "Document Format" dropdown select whether or not to include the red background.

 Click the green "Download" button to download the CMS-1500 form(s).

 

Next:

  • Follow the normal downloading steps for your internet browser. The files download into your computers "Downloads" folder.
  • Open the file in a PDF viewer.
  • Proofread the CMS-1500 carefully. 
  • Print and mail the form to the payer's paper claims address.

Items Not Showing Up Under "Create CMS-1500" Screen 

If the dates of service are not showing up under this screen, the line item needs the method set to "Paper". Follow the instructions above in the section "Set 'Paper' per Billing Line Item" to fix this. Then when you click "Create CMS-1500" the items will appear. 


Create CMS-1500 for Secondary Insurance 

TherapyNotes allows you to create a CMS-1500 form for secondary insurance to mail along with a copy of the explanation of benefits (EOB) or electronic remittance advice (ERA) from the primary payer. To learn how to create a CMS-1500 for secondary insurance, see this article


 Enter Insurance Payment

Once you receive payment from insurance, post the payment to TherapyNotes.

  • For a visual tutorial on Assisted ERA Payment Posting, see this article
  • For a visual tutorial on entering insurance payments, see this article
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Comments

  • Avatar
    Michelle Moreno

    Is there a way to print the CMS form with the signature box in the bottom left corner blank? I've had CMS forms returned because they wanted an original signature from the provider and there isn't a place to do it unless I sign on the bottom margins.

  • Avatar
    Laura

    Michelle,

    Unfortunately there is not a way to blank out this information in TherapyNotes. One workaround is to edit the PDF before printing the CMS-1500 form. Another is to white-out the box after printing it and hand-write over it.

  • Avatar
    Terianne Harrison

    How do I edit the PDF so I can delete information before printing?

  • Avatar
    Sean Behan

    Hi Terianne,

    A member of our support team will reach out to you for assistance.