Important Recommendation for Healthcare Providers

by Cowboy Bob Sorensen

Even before the COVID-19 crisis, there is something very important, very basic, and what should be very simple for healthcare providers to utilize that should make receiving payments more efficient. Although we are going to consider HCFA (pronounced HICK-fuh) forms, the principles apply to others as well. As providers, you want to be paid, right?

Image credit: Freeimages / Adam Ciesielski overlaid with partial HCFA form

The HCFA 1500 form was designed for Medicare and Medicaid. It is used for other claims as well. Many providers use software to fill out the forms, but a large number are filled out by hand. You fill them out and send them off to the insurance company, and most of these are scanned using OCR software so those of us behind the scenes can use our software to correct OCR errors. Then claims examiners can make sense of them and you can get paid. Nobody needs faulty submissions and delays — especially during a pandemic.

There are several errors made when filling out forms that delay your claim. This can mean problems for your patients (especially when you incorrectly bill procedures, then the patient receives a substantial bill for services that are actually covered under their plans), and you can also foul up and delay the claim so badly that you have to "eat" the financial loss.

I complained to a supervisor long ago that many providers have no idea how to fill out the forms. After all, the instructions are available. I was told that the providers are not the ones filling out the forms, staff members are doing this. That is not entirely accurate, but even so, the staff members are supposed to be trained and supervised; providers are ultimately responsible. In addition, insurance companies use lingo such as "training the providers" by alerting them to errors, but I lack belief that they are consistently doing this.

Use the Proper Forms

Even though many forms are standardized, Ultrabig Health Insurance is likely to reject Rival Lesser Insurance's forms, and vice versa. Also, you do not want to be sending a HCFA when the company simply needs a different notification form. Your submission is sent back, you have to fill out the correct form, everything is delayed.

Write Legibly

Some submissions are so poorly written, OCR and data entry processors are unable to read them. I have seen entries where I cannot tell if that is a seven, nine, zero, or something else. In fact, I have seen forms that looked like the provider or staff (herein, provider also includes staff) was trying to be cute. If you want to express your individuality, the forms are not the place for it. (Office decor, have a great time.) Far too many are partially or almost entirely illegible. We know you're in a hurry. Slow down enough to make it decipherable.

Use Proper Printer and Software Settings

It is not an exaggeration to say that I have seen thousands of forms where the software or typing layout is not properly aligned. Important information is clipped from the margins. Also, instead of being between the lines of the forms, important information is "speared" by the lines and mixed with the headers. For example, Box 23 is "Prior Authorization Number". We cannot read the number if it is "33D something something something". The entire form can be poorly calibrated so the information is shifted. This includes patient identification, diagnosis codes, provider name and address, and so on. We need to see these things.

Related to this is the use of a proper font. Times New Roman, Arial, or something that make it possible to distinguish a zero from an O, or a one from an L, may be unexciting but they make processing the forms more efficient.

Do not use tiny type sizes. I have seen unnecessarily small type and space is seldom at a premium. Sometimes the provider's organization name is ultra small and the rest of the information is in normal type. That is counterproductive and takes extra time.

Crammed Tables

There are providers that take the six-column table for dates, places, etc. for service and cram more than six entries into them — even twelve entries. Perhaps the plan to which you are submitting these allows (or tolerates) it, but you may want to consider attaching another sheet.

Addresses

Many times, an address is too long. Sure, you or a patient cannot help it if  you work or they reside at a location has a long street name. However, you can mitigate damages, so to speak, by using postal abbreviations such as Ste, Rd., St, Ave, Apt, and so on. Those may help keep the information from being cut off.

A few providers may write out "USA" or "United States" after the city, state, and ZIP code. We know where you're from by the postal code and the telephone number — and because the overwhelming majority of claims are in the United States. A provider in, say, Moldova may want to write in the country name.

Provider Signature

HCFA Box 31 is for the provider or person in charge of filling out the forms. Many use "Signature on File". But why use a script font instead of a signature or "on file" notation? That is unnecessary and slows down the processors.

Patient Signature

This should not be difficult. Boxes 12 and 13 are for the patient or authorized person to sign. They are not for the provider. You have your own space. By the way, when it says "degrees or credentials", you can keep it short: Maj. Janet Fraiser, MD. We are not interested in your associates, fellowships, and so on. That was important in the credentialing process when you signed up to be a provider for a health plan, but on claim forms it is just unimpressive and adds clutter.

Provider Location

In Box 32, "Doctor's Office" or writing a street location twice are not helpful. Also, some extremely long provider names in Box 32 spill over into Box 33 and push out most of the name. Using a second line for a long organization name should be possible.

Rubber Stamps

When I see a rubber stamp in the provider information areas of Box 32 and Box 33, it says to me, "I don't care and I'm lazy". Fill it out properly or set up your software. Rubber stamps are often crooked, incomplete, and obliterate other information due to poor stamping procedure.

Extraneous Writing

If you really need to put notes on the form, kindly be sure you are not obscuring information that the form requires. Box 19 is for "Local Use", which may meet your needs. Attaching a separate letter is worth considering.

Leading or Extra Zeroes in Prices and Units

It is baffling and a waste of time to enter $0000062.00 or a unit of 005.0000 mg. Those extra zeroes do not change the value or quantities. $62.00 or 5.00 mg is sufficient. Capisce?

I had more items to list, but you get the idea. People's lives are in your hands, and if I had to find a provider that did these things, I would assume they don't care enough to get the details right.

"You have no business instructing me or talking to me this way! Do you know who I am?"

Maybe. But I don't care who you are. We have to process thousands of claims from providers in large corporate practices as well as the small provider. They're all letters and numbers on our screens, and we have to do these as efficiently and accurately as possible. 

Do you know who I am? Of course not! I am just one of many at the bottom of the food chain who are doing the best we can with the information that is available. We can't help you if you don't help yourself by giving us legible information that is as complete as your plan requires. You want to be paid, right? You'll thank us later.