Question

CMS-1500 (The Centers for Medicare-Medicaid Service) insurance claim form, previously known as HCFA-1500 claim form, is also known as the:

A) UB-04 form
B) ICD-10 form
C) EOB form
D) Redetermination form

Answer 1

The CMS-1500 is a professional billing insurance claim form used to submit health care services claims to payers like Medicare and Medicaid, and it is not the same as any of the options provided (A-D). It is a critical form in the fee-for-service model, where reimbursement is tied to the cost of provided services.

Step-by-step explanation:

The CMS-1500 insurance claim form, known previously as the HCFA-1500 claim form, is utilized for submitting physician and certain other health care services' claims to payers like Medicare and Medicaid. The correct answer to the question "CMS-1500 insurance claim form is also known as the:" is none of the provided options (A) UB-04 form, (B) ICD-10 form, (C) EOB form, or (D) Redetermination form. The CMS-1500 is specifically for professional billing and is distinct from the UB-04 form, which is used by institutional providers for billing hospital services. The ICD-10 form refers to the International Classification of Diseases, 10th Revision, which is a coding system used within the CMS-1500 form, but not the name of the form itself. An EOB or Explanation of Benefits is a statement sent to covered individuals explaining what medical treatments and services were paid for on their behalf, not a claim form. A Redetermination form is used to request a reconsideration of a payment decision, not for submitting service charges.

The health insurance landscape includes various concepts like Medicare, Medicaid, and the Patient Protection and Affordable Care Act (ACA or Obamacare), which have restructured how health care is financed and provided. Part B of Medicare covers physician services, medical tests, outpatient visits, and more, requiring a monthly fee, deductible charges, and copayments, with significant government contributions. In a fee-for-service health financing system, providers are reimbursed for the cost of services they provide, which differs from arrangements such as Health Maintenance Organizations (HMOs), where providers are reimbursed based on the number of patients they manage.