CHECKLIST 19-4: Complete a Computerized CMS-1500 Claim Form

Part I: Format/Documentation requirements of Operative Report and Encoder Pro NCCI edits. Complete and design format/documentation requirements of Operative Report. Review Operative Report to identify the documentation supporting the procedures and diagnosis, to determine CPT codes/ICD-10-CM codes supported by documentation. Use Encoder Pro NCCI edits and apply correct modifiers to unbundle or bypassed NCCI edits. Print Encoder Pro NCCI edits as proof of resolving edits.

Part II: Resolve discrepancies between supporting documentation and coded data. Create a query physician form to resolve discrepancies. Provide necessary supporting materials such as CPT description, coding tips/coding guidelines from Encoder Pro or CPT manual to educate the provider if needed.

Part III: Review patient registration form and the list of codes approved by the provider. Follow the steps to complete a computerized CMS-1500 form. Use the CMS website Physician fee schedule to determine the charges for each CPT code submitted. Additional exercise using the Progress note from checklist CQMR (rejection with missing/incomplete documentation). Print the CMS 1500 for the two exercises.®Do not do the highlighted part. It is already done.

Part IV: Investigate potential fraud and abuse with the billing and coding procedures involved; justify the application of the AHIMA Code of Ethics. Determine the importance of coding quality and accuracy before completion of CMS 1500. Recommend necessary procedures/policy for coding quality and documentation compliance. Describe the role of the Health Information professional to coding quality, compliance, and reporting. Describe the role of the provider to clinical documentation improvement.

ANSWER QUESTION 1-4 IN A ESSAY FORMAT. TIME NEW ROMAN 12 FONT.