CMS-1500 (PQRS Ready)

Your billing staff will thank you for saving them so much time! Most of the CMS-1500 is filled in automatically from other parts of HearForm. Templates make CMS creation even faster. We have added a PQRS module to help your practice receive the financial bonuses available starting January 1, 2013. Print CMS forms on pre-printed forms or send them electronically to any clearinghouse that accepts our print image format. These currently include... ENSHealth, Apex EDI, Emdeon, Capario, Office Ally, E-Claims and National EDI.

CMS-1500 (PQRS Ready) - Financial and Billing

HearForm allows you to complete the CMS-1500 all on one screen or work from one tab to the next, reducing the need for scrolling up and down. Here is the full form entry screen:

  • There are also two fields dedicated for the “Amount Refunded.” (You may have a policy of refunding the patient balance in two payments.)
  • The “Refund Type” field is optional. It is simply used as a way to designate one refund type from another. It is not used in reports.
  • The Return document may be printed as a return receipt for the patient who cancels or exchanges instruments.
  • You can use the green “RTN” buttons on this screen or on the sales tab, as mentioned earlier. Since both the sales and return screens display essentially the same data, anything entered here will be reflected on the sales screen (and vice versa.)

The delivery receipt may be customized for your specific needs.

CMS-1500 (PQRS Ready) - Financial and Billing
  • Fields 1...13 - CMS-1500 (PQRS Ready) - Financial and Billing

    Fields 1...13

  • Fields 14...23 - CMS-1500 (PQRS Ready) - Financial and Billing

    Fields 14...23

  • Fields 24 - CMS-1500 (PQRS Ready) - Financial and Billing

    Fields 24

  • Fields 25...33 - CMS-1500 (PQRS Ready) - Financial and Billing

    Fields 25...33

  • Electronic Clearinghouse Export Screen - CMS-1500 (PQRS Ready) - Financial and Billing

    Electronic Clearinghouse Export Screen

  • Print to Paper Screen - CMS-1500 (PQRS Ready) - Financial and Billing

    Print to Paper Screen

  • PQRS Explanation Screen - CMS-1500 (PQRS Ready) - Financial and Billing

    PQRS Explanation Screen

  • Measure #130 of the PQRS Module - CMS-1500 (PQRS Ready) - Financial and Billing

    Measure #130 of the PQRS Module

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