Instructions for the HCFA Form

Medicare will pay for medical treatment if you are covered under the program. You must obtain a CMS-1500 form, formerly known as a HCFA-1500 form. The forms are available at participating print shops, through the U.S. Government Printing Office and are commonly provided by medical practitioners. The form is on white paper and printed in red ink. The form must be filled out accurately and mailed to Medicare and the medical provider within one year of the received medical treatment.

Instructions

• 1

  Obtain a CMS-1500 form in its proper format --- Medicare will not accept an application made in an improper format. The application must be on white paper with red print and must be able to be fed into optical character recognition equipment. Buy the forms from the U.S. Government Printing Office or obtain the forms from your medical practitioner to make sure they are acceptable.

• 2

  Use black ink to fill out the form. Proceed slowly and look for icons that direct you to appendices or to attach required documents such as a medical bill. All boxes that are shaded are not required to be filled out while all clear white boxes must be filled out completely.

• 3

  Get the help of the health care provider to use terminology approved by the American Medical Association. The health care provider will also help you with some medical coding in certain sections. Sign the form in two required spaces and have the health care provider sign in one required space.

• 4

  Mail the original copies to the Medicare provider. The Medicare provider will send back copies of the original document or applications with errors. The application must be submitted or resubmitted within one year of the health care service.