Staying up-to-date with the inner workings and changes of medical billing is important. The medical industry is always advancing, so staying well informed is key to ensuring that your office will run smoothly with fewer denied claims.  Some information is more important than others, so here we’ve covered what medical billing questions you should ask.

Question #1: Who is able to bill claims with the CMS-1500 code?


Answer: The CMS-1500 code can be used for non-institutional providers and/or medical suppliers. These providers and suppliers can qualify:

  • Ambulance services
  • Certified registered nurse anesthetists
  • Clinical nurse specialists
  • Clinical psychologists and social workers
  • Nurse practitioners
  • Physician’s assistants
  • Certified nurse midwives
  • Clinical diagnostic lab services providers
  • Home dialysis supplies and equipment providers

Question #2: When Medicare is not the primary insurance, what refers to Medicare benefits?

Answer:Medicare Secondary Payer (MSP) can be used to define benefits available when Medicare is not being used as a patient’s go-to insurance. Medicare is generally used as the primary insurance when the patient is at least 65 years old and has a small group plan through a spouse or their own employer or has insurance that is available through a retirement program. Medicare can also be used as principal insurance if the patient is disabled.

Question #3: How do you determine the payer of last resort?

Answer: When a patient has coverage under other health care plans, Medicaid is always the payer of last resort. It’s also important to note that providers must inform Medicaid of any third party insurance that they are aware of. Providers must also notify Medicaid if they receive payments on behalf of the patient.

Question #4: Are there questions to identify MSP situations?

Answer: To determine MSP situations, use the Medicare Secondary Payer Questionnaire. These questions should be distributed to the patient during the admission process, which is helpful in saving time, as it determines which payers are primary or secondary.

Question #5: Which procedure codes to physicians most commonly use?

Answer: There are a variety of CPT codes that are commonly used by doctors when they see and treat patients. These codes are the most common for evaluation and management:

  • 99201-05 (New Patient Office Visit)
  • 99211-15 (Established Patient Office Visit)
  • 99281-85 (Emergency Department Visit)
  • 99241-45 (Office Consultation)

Knowing the answers to these questions will help minimize confusion and frustration with both patients and medical providers and bolster efficiency in the billing process. Looking to implement processes in your office that will help provide quality healthcare to each patient? Read more about how our medical billing management service works for hundreds of clients around the state.