Office Administrative Assistant Practice Exam

In which blocks of the CMS-1500 form is the patient's signature located?

1. Blocks 10 and 11

2. Blocks 12 and 13

3. Blocks 14 and 15

4. Blocks 16 and 17

The correct answer is: Blocks 12 and 13

The patient's signature is located in blocks 12 and 13 of the CMS-1500 form. Block 12 is where the patient or their authorized representative can sign to authorize the release of medical information necessary to process the claim. This signature indicates the patient's consent for the medical provider to submit a claim for the services rendered. Block 13 is where the patient or authorized representative also provides a signature acknowledging that they understand that payment may be made directly to the provider. Combined, these blocks are essential in validating the claim and confirming that the patient agrees to the terms outlined for billing. The other blocks mentioned do not pertain to the patient's signature; rather, they serve different purposes related to patient information and provider details in the medical billing process.