Certified Revenue Cycle Representative (CRCR) Practice Exam

Which type of provider typically uses the CMS 1500 form for billing third-party payers?

1. Private practice physicians

2. Hospital-based mammography centers

3. Urgent care centers

4. Laboratories

The correct answer is: Hospital-based mammography centers

The CMS 1500 form is primarily used for billing services provided by healthcare professionals in outpatient settings and is particularly relevant to private practice physicians and independent providers. These providers submit claims to third-party payers, such as insurance companies, using this standardized form. While hospital-based mammography centers may submit claims through the CMS 1500 form, they typically bill under a different procedure using a UB-04 form, which is more common for facilities offering a range of services, including outpatient hospital services. Likewise, urgent care centers and laboratories are also primarily services that would utilize the CMS 1500 form, as they operate independently in a way that aligns with the use of this type of billing document. Therefore, the most accurate response regarding the typical use of the CMS 1500 form for billing third-party payers is private practice physicians, as they regularly operate within the framework established for outpatient claims in the healthcare revenue cycle.