UB-04 FAQ:

Billing on the Institutional Claim Form, UB-04

The UB-04 is the standard bill form used specifically for billing facility-based services rendered to patients who have been admitted to an inpatient setting with beds, as opposed to the CMS-1500 for physician-rendered services. These settings may include small hospitals, surgery centers, long-term care, sleep studies, skilled nursing, and other facilities that offer beds for patient admission, such as ambulance, hospice, and rehabilitation facilities (see the complete list below).

Previously referred to as the CMS-1450 form, the UB-04 claim form is most frequently used for billing facility services. The type of facility is an important factor in choosing the appropriate claim form. Facility billing is separate from billing for physician-provided services, including anesthesia and surgical procedures provided by surgeons at the facility, which are billed on the CMS-1500 form. However, non-physician services are performed in an institution, and the facility bills for them as an institutional service under the UB-04 claim form through UB-04 software.

What Is UB-04 Software Within Medical Billing?

UB-04 applications keep thorough information about the supplies given and the payments made by the office to get compensation from protection and well-being benefit payers. Such software allows providers to enter all relevant data, such as patient demographics, diagnosis codes, procedure codes, service dates, and itemized charges for all services performed. The UB-04 form helps ensure consistency in billing practices between different healthcare providers, allowing for efficient processing of facility-based claims for reimbursement.

The UB-04 claim form is a key component of the revenue cycle management process used in the world of medical billing. It serves as a documentation tool for capturing the information necessary for reimbursement. Correct and thorough form completion helps healthcare providers avoid claim denials, reduce UB-04 billing mistakes, and ensure faster payment.

What Is the Difference Between CMS-1500 and UB-04 Software?

UB-04 software is different from the claim preparation software for the CMS-1500 form, which is specific to professional services rendered by individual providers. The CMS-1500 form is used for physician billing, whereas the UB-04 form is used for institutional billing and includes more fields and requirements related to facility services. The UB-04 claim form (previously referred to as the CMS-1450) is another standardized insurance claim used in medical billing by institutions for services provided to patients while in-house. This is critical for properly documenting and billing for non-ambulatory services for reimbursement from insurance companies, Medicare, or Medicaid. Unlike the CMS-1500 form, which is used for professional services provided by individual professionals, this form is used for institutional services.

What Are UB-04 Bill Types?

There are several components, fields, and sections that are key to fill on the UB-04 claim form for vital information for medical billing. Here’s a rundown of some of the highlights: Patient Information: This part includes the patient’s name, address, date of birth, sex, and other useful demographic details, which help in identifying the patient as well as ensuring accurate billing.

• Provider Information: This shows the name and address of the healthcare provider or facility, as well as the provider’s National Provider Identifier (NPI) and Medicaid provider number, helping identify the entity billing insurers and the address for reimbursements.

What Is Type of Bill, or Service Type?

The UB-04 Type of Bill field indicates the type of healthcare service being billed, such as inpatient, outpatient, emergency room visit, or specific procedures. Example: The UB-04 outpatient bill type is represented as “013X” in general.

– Revenue Codes: These describe and classify the different services or supplies that a patient provides and help in identifying the exact service or item for which the reimbursement is requested, including:

• Laboratory tests

• Radiology services

• Medications

• Surgical supplies – UB-04 bill type for emergency room visits

• Service Dates: This field captures the service start and end date for the patient, which is important to document the duration of stay or date of service for specific procedures.

• Diagnosis and Procedure Codes: These codes are representations of the patient’s medical condition as well as the services or procedures performed. Diagnosis codes (usually represented by ICD-10 codes) describe the patient’s diagnosis or the reason for the healthcare services. Procedure codes, including Current Procedural Terminology (CPT) codes or Healthcare Common Procedure Coding System (HCPCS) codes, describe the services or procedures performed. The revenue codes and admission codes that fall under the UB-04 claim form are essential components for determining and categorizing services and supplies provided under the hospital admission type codes, such as:

• Emergency

• Urgent

• Elective

• Newborn

These codes help provide details that relate to institutional or facility billing.

A UB-04 claim form includes items like patient information, provider information, Type of Bill field, revenue codes, service date, and diagnosis and procedure codes. It is used for billing for a number of services provided in institutional settings such as hospitals, which ensures completeness of information necessary to get paid. These codes and fields assist in the correct coding and recording of the services rendered.

What Are UB-04 Type of Bill Codes?

Different types of bill codes are used on the UB-04 claim form to classify the different types of healthcare services provided. Here’s a rundown of the UB-04 type of bill codes:

• Inpatient Services: Acute Care: An inpatient bill type (e.g., bill type 111) including inpatient services in an acute care hospital. – Hospitalization: Examples are type of bill 121 or 113 for a variety of hospitalization types (e.g. Medicare Part A, Medicare Part B, and Medicaid hospital stays). Particular codes may also denote specialized inpatient services such as bill type 117 for psychiatric admissions. — Visits to Clinics: States use bill codes such as 731, used for billing various inpatient clinic services, including end-stage renal disease.

• Outpatient Services: – Surgical Procedures: Certain outpatient surgical procedures are billed on UB-04 type of bill 131.

• Diagnostic Tests: There are different types of bills used to represent outpatient diagnostic tests such as laboratory tests or radiology services.

• Skilled Nursing Facilities: – Long-term Care: These types of bills represent long stays in skilled nursing facilities for long-term care services. Very specific bill types are used for rehabilitation services rendered in skilled nursing facilities.

• Home Health Services: — Home Care Visits: These codes represent a variety of home health services, including nurse or home health aide visits.

• Nursing Services: There may be additional coding specifically for nursing services offered in a patient’s home.

• Hospice Care:

• Palliative Care: A bill of this type falls into the category of palliative care, or the services used to determine hospice program eligibility.

• End of Life Care: These codes may also represent end-of-life care services provided by a hospice agency.

• Ambulance Services:

• Emergency Transportation: These types of bills are used for emergency ambulance transportation services.

• Non-Emergency Transportation: These codes refer to non-emergency ambulance transportation, such as to medical appointments. The list here is meant to be illustrative only; there are more specific bill types for different services and scenarios. Providers should refer to the UB-04 type of bill codes list from the Centers for Medicare and Medicaid Services (CMS) for more in-depth information regarding available bill types and their proper use.

The Role of Compliance in Medical Billing with the UB-04

There are several reasons why accurate coding of UB-04 type of bill is critical.

• Reimbursement and Revenue Impact:

Reimbursement varies greatly, largely depending on the bill code type (UB-04). Each bill type is associated with a specific payment rate or reimbursement methodology. Accurate coding of service type ensures that the providers are reimbursed accordingly for the service performed. Coding that is not accurate or does not meet that level of care may result in being underpaid or overpaid, which affects the facility’s bottom line.

– Regulatory and Guideline Compliance:

Accurate UB-04 code assignment is vital to complying with the billing regulations and guidelines set by private payers. These entities currently have specific coding and claim submission requirements. UB-04 codes are adopted, as part of compliance, to ensure billing practices are accurate and help avoid penalties, audits, and further legal woes.

• Reducing Rejections and Errors in Billing:

Accurate coding of UB-04 types will reduce errors in billing and claim rejections. Incorrect coding can lead to rejection of the claim or delayed reimbursement, resulting in increased administrative pressures and loss of revenue. A key benefit of ensuring the company highlights correct coding is that the provider will reduce the likelihood of errors and rejections, creating a more streamlined process for billing.

• Ensuring Complete Documentation and Auditing:

Accurate UB-04 coding facilitates proper documentation of the services rendered to the patient. Proper coding ensures that patients receive a clear record of their medical condition and the care provided.

Another essential use of UB-04 documentation is for audits and quality assessments performed by regulatory bodies. Proper coding aligns billing for services with the review of compliance examples presented to auditors while also demonstrating medical necessity for the care rendered.

For healthcare providers, accurate UB-04 type coding is the key to successful claims. Proper billing code management assists in improving revenue cycle management, accurate billing, and proving compliance in healthcare billing.