Certified Revenue Cycle Representative (CRCR) Practice Exam

What type of provider uses the CMS 1500 form to bill third-party payers?

1. Office-based physicians

2. Hospital-based mammography centers

3. Urgent care facilities

4. Rehabilitation centers

The correct answer is: Hospital-based mammography centers

The correct answer is that office-based physicians use the CMS 1500 form to bill third-party payers. This form is specifically designed for billing outpatient services provided by non-institutional providers, which includes individual physicians or group practices operating in an office setting. Understanding the use of the CMS 1500 form is crucial in revenue cycle management, as it facilitates the claims process by providing essential patient and service information to payers. While hospital-based entities and facilities such as mammography centers, urgent care facilities, and rehabilitation centers may have specific billing requirements, they typically utilize a different form, such as the UB-04, for institutional billing. This distinction clarifies that the CMS 1500 form is primarily associated with billing conducted by office-based healthcare practitioners.