Question

If you do not file the CMS-1500 form in time and the claim is late, then _____.

a) the physician can bill the patient for the services
b) the carrier may not pay anything on the claim
c) you will submit the claim by mail
d) payment will be delayed

Answer 1

If the CMS-1500 form is not filed on time, the carrier may not pay for the claim at all. It is critical for healthcare providers to submit these claims promptly to avoid denial of payment.

Step-by-step explanation:

If you do not file the CMS-1500 form in time and the claim is late, then b) the carrier may not pay anything on the claim. This is because health insurance carriers typically have filing deadlines for claims submission. If these deadlines are not met, the carrier has the right to deny the claim, potentially leaving the provider unable to receive payment for services rendered. While the physician could bill the patient directly, this is often subject to the terms of the patient's insurance policy and any contractual agreements between the provider and the insurance carrier. Therefore, it is crucial for healthcare providers to submit claims in a timely manner to ensure they receive appropriate compensation for their services.