What should a billing and coding specialist complete to be reimbursed for a provider's outpatient services?

A billing and coding specialist should complete the CMS-1500 Claim form to be reimbursed for a provider's outpatient services because this form is specifically designed for use in outpatient settings. The CMS-1500 form is utilized for billing Medicare and various other third-party payers for services rendered by non-institutional providers, such as physicians and other healthcare professionals.

This form captures essential information about the patient, the services provided, the diagnosis, and the provider, which are all necessary for the reimbursement process. It includes itemized service details and corresponding codes, such as ICD codes for diagnoses and CPT or HCPCS codes for procedures.

Other options, while related to billing, are not suitable for outpatient services. The UB-04 form, for instance, is meant for institutional services and is generally used by hospitals or skilled nursing facilities. The encounter form, also known as a superbill, is an internal document used by providers to capture services during a patient visit but is not submitted to payers for reimbursement. The billing summary provides an overview of charges but does not contain the specific details required for billing and is not submitted for payment. Therefore, the CMS-1500 Claim form is the appropriate choice for outpatient service reimbursement.