Health Insurance Today Hospital Billing And The Ub-04 Test Question Facility Insurance Billing – Billing Insurance on UB04 Forms Correctly

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Facility Insurance Billing – Billing Insurance on UB04 Forms Correctly

Facility billing is insurance billing for hospitals, inpatient or outpatient clinics, and other offices such as ambulatory surgery centers. This insurance billing is not the same as billing a regular doctor or specialist.

Facility billing is required to be submitted on UB04 forms instead of the more common CMS 1500 forms. The information required on UB04 forms is different than the information required on CMS 1500.

For example, the UB04 forms require rev codes and a type of bill code that is not required on the CMS1500 form. There are also several “conditional fields” that for most situations do not need to be completed. It is important that you know how to complete the UB04 form correctly in order to get paid correctly from the insurance carrier.

Some offices may charge as facility and professional billing. We pay for an outpatient drug and alcohol rehab facility owned by an LCSW. Some insurance carriers credential it as a facility and require billing to be done on UB04 forms. This is beneficial to our client because the facility payment rate is higher than the professional payment rate. But some insurance carriers will not credential him as a facility and he must bill the services to them on CMS1500 forms as regular therapy visits.

So you may find yourself in a position where you need to pay both the UB04 and CMS 1500 forms. In any case, it is important that you complete the forms correctly.

When we first learned how to submit UB04 forms, they were actually the old UB92 forms. We had to buy a book called the UB92 editor which is a detailed book on what all the UB92 form fields are. This is helpful, but there is actually a lot of information. The book is difficult to navigate and is actually quite expensive. The information it contains is necessary if you are doing in-depth inpatient billing, but for smaller people, such as outpatient clinics, it is too much information and very difficult to decipher. We receive many questions from people trying to complete a UB04 form correctly.

In order to complete the UB04 forms correctly for facility billing, it is very important to understand the differences in billing procedures between the CMS 1500 forms and the UB04 forms. Make sure your claims are paid correctly the first time they are submitted.

Copyright 2007- Michele Redmond

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