The CMS-1500 (HCFA) Form is used by healthcare providers and professionals to file original workers' compensation medical bills in Mississippi.
Article Contents |
Navigation Link |
CMS-1500 (HCFA) |
|
Filling out the Form |
|
Required Reports |
|
Timely Filing |
CMS-1500 (HCFA) Services
The following table provides a link to the Mississippi rules which require a provider to use the CMS-1500 (HCFA) for billing purposes. The rules do not specifically mention any services in particular; the following are suggested based on common practice.
Service |
Rule |
Physician Services |
|
Laboratory / Pathology | |
DME | |
Dispensed Pharmaceuticals |
CMS-1500 Form Instructions
The state of Mississippi requires providers to compliantly complete the CMS-1500 Form but provides no further specification.
To make things easier for you, DaisyBill created this NUCC CMS-1500 Instructions Table showing the requirements of the National Uniform Claim Committee (NUCC), the entity which created and maintains the form. This information is provided for educational purposes only and is not intended to represent state-specific requirements.
For additional information, review the complete NUCC Manual:
1500 Health Insurance Claim Form Reference Instruction Manual for Form Version 02/12
CMS-1500 Required Billing Documentation
For a complete bill, Mississippi requires the provider to submit the following supporting documentation with the CMS-1500 Form, when applicable.
CMS-1500 Medical Bill |
Required Documents |
Treatment |
Initial office visit notes which document a history, physical examination, assessment and plan appropriate to the level of service indicated by the presenting injury/illness or treatment of the ongoing injury/illness.
Progress notes which reflect patient complaints, objective findings, assessment of the problem, and plan of care or treatment. |
Surgery |
Operative reports, consultation notes with report, and/or dictated report. |
Radiology |
Copies of lab, x-ray, or other diagnostic tests that reflect current progress of the patient and/or response to therapy or treatment |
Laboratory |
Copies of lab, x-ray, or other diagnostic tests that reflect current progress of the patient and/or response to therapy or treatment |
PT / OT |
Physical medicine/occupational therapy progress notes that reflect the patient’s response to treatment/therapy.
A progress report every thirty (30) days for therapy services/treatment (P.T., O.T., C.M.T., O.M.T.); |
Anesthesia |
The anesthesia record for anesthesia services; |
FCE |
A functional capacity or work hardening evaluation; |
By Report |
When billing “By Report” (BR), a description of the service is required; this description should include an adequate definition or description of the nature, extent, and need for the procedure and the time, effort, and equipment necessary to provide the service; |
For additional information related to reporting please refer to DaisyBill’s Mississippi Billing Guide.
Timely Filing
Medical Bills must be filed within 20 days of the date of service for services rendered in Mississippi.
Form |
Timely Filing |
General & Procedural Rules of the Commission |
Mississippi Workers’ Compensation Commission Rule |
Medical Bills |
20 days from DOI |
Laws and Claims General & Procedural Rules Of the Commission |
Back to Top
DaisyBill Solution
Stay up-to-date on the latest developments in Workers’ Compensation medical billing by subscribing to DaisyBill’s email list.