Tim just started a job as a billing and coding specialist and is learning all about what forms to use for the physician's office he works for. Tina tells him that the office uses the universal insurance claim form, the CMS-1500. She explains that all insurance plans they provide coverage for take this form and that he must use it for all claims.
Tina further explains that although she tries her best to be accurate with all claims, sometimes the writing in a medical record is illegible or she comes across an unfamiliar term. Because she is so busy, rather than take the time to clarify the note or look up the term, she makes an educated guess and proceeds with the claim.
Do you agree or disagree with Tina’s way of filling out an insurance claim form, and why or why not?
What rules or guidelines would you suggest she follow when filling out a claim form accurately?
What are the potential consequences of her actions if her claims are not accurate?