2014 ub 04 manual for billing hospital claims 2nd edition answer key

The ub 04 claim form is used to submit claims for inpatient hospital accommodations for example, medicalsurgical intensive care, burn care and coronary care and ancillary charges for example, labor and delivery, anesthesiology and central services and supplies. A reference and training tool for efficient operations in health care facilities. Coverage policy for inpatient and outpatient hospital services. Filing medicare part a crossover claims on the ub04. August 2020 split billing a hospital stay the following policy pertains to hospitals reimbursed according to drgreimbursed or nondrg reimbursed methods, as indicated. Handbook for hospital billing, without answer key, print. Commonwealth of kentucky ky medicaid provider billing. The following table can be found in ub 04 tips for billing.

On a noncolor printout, required fields will appear darkest. Overview of the ub04 billing claim form verywell health. For record keeping purposes only and to help reconcile payment on the remittance. You can access the ub 04 billing information adopted by the nubc by subscribing to the official ub 04 data specifications manual. Hospital ub04 claim filing instructions, section 2 billing book. Handbook for hospital billing, with answer key, print edition. Atypical providers are providers who do not provide medical service and therefore are exempt from obtaining and billing with a npi. Enter the appropriate threedigit code to identify the type of bill being submitted.

Ub 04 handbook for hospital billing, with answer key. Dates of service are required for outpatient hospital services. The ub 04 is a uniform institutional bill suitable for use in billing multiple third party liability tpl payers. This update replaces the october 2006 practice brief key points of the ub 04. She receives counseling from a pa regarding the dmpa. Hospital billing book, complete missouri department of social. The following paper claim form requirements and standard billing procedures can speed claim processing and prevent delays. Ub04 billing instructions partners health management. All other providers are required to bill with their npi. Ub 04 claim form completion for promise icfmr, icforcs and state mr centers.

In some cases, claim submission may be necessary on ub 04 paper. Section 2 ub04 claim filing instructions november 2012 2. If left blank, will default to first date of service. Pay to address pay to address if different than field 1. Handbook for hospital billing, without answer key, print edition. Medicare part c onlymississippi medicaid part a crossover. For detailed form locator information, all providers should have a copy of the ub 04 data specifications manual for reference. The ub 04 claim is printed with dropout ink and that the form meets national uniform billing committee nubc standards. Medicare claims processing manual chapter 25 completing and processing the form cms1450 data set table of contents rev. In this instance, you must follow all the coverage, coding, and billing requirements for physician services. When submitting the above claims, complete all items required by each payer who is to receive a copy of the form. Medicare claims processing manual chapter 3 inpatient hospital billing. Submitting the claim form with all required fields will assist us in paying your claim in a timely manner. Coverage, claiming, and billing policies related to.

Used for the first of a series of bills for the same confinement or course of treatment. Effective 41 2014, ampm policy 431 epsdt oral health care. Billing practice chapter 7 hospital outpatient billing chapter 8 hospital inpatient billing chapter 9 other facilities using the ub part iv. Mailing instructions follow the claim preparation instructions. The centers for medicare and medicaid services cms form 1450, referred to as the ub 04, is the standard claim form used to bill facility services to us and our affiliates. Use this code when a claim for a course of treatment has been submitted and further claims are expected to be submitted. Please note that these instructions are specifically written to correlate with partners behavioral health managements claim management system alpha mcs. Ub 04 special billing instructions for outpatients page updated. In 2005 the national uniform billing committee nubc approved the uniform bill ub 04 paper claim and data set as the replacement to the ub 92 paper form. Medical provider training 2017 garner health law corporation. This information is designed to supplement the explanations in the ub 04 completion.

Making copies or utilizing the content of the ub 04 manual, including the codes andor descriptions, for internal purposes, resale andor to be used in any product or publication. It is to be used as a companion to, and not a replacement for, the ub 04 data specifications manual, available from the national uniform. When submitting a claim for a service period where all days are medicare coinsurance days, for long. Updated fl4 in all detailed billing instructions and. The ub manual and the ub 04 chapter 3 the ub manual and form locators 14 chapter 4 form locators 541 chapter 5 form locators 4249, revenue codes chapter 6 form locators 5081 part iii. Separate claim forms must be prepared for a hospital stay. Enter one of the appropriate codes indicating the priority of this admission. The following changes apply to ub 04 hospital billing for. First digit type facility 8 special facility hospice b. Claim submission requirements for facilities information for. Used when a bill for the same confinement or course of treatment has. Ub04 requirements for hfs adjudication attachment to ub04. These instructions are to be supplemented with the information and codes in the uniform billing manual for the ub 04.

Terminology, 4th edition, cpt4 for physician services and cms developed. This manual, ed by the american hospital association, is the only official source of ub data. A critical access hospital cah is one that is certified to receive costbased reimbursement from medicare. This guide gives detailed line by line instructions on how to complete the ub 04 claim form. Learn hospital billing completing ub 04 claims with free interactive flashcards. The total health care claims provider manual is designed to assist the provider in understanding the specific policies, procedures and billing guidelines of the health plan. Inpatient claims page 1 instructions for completion of this form follow in the order entries appear on the form. Dates must be within the fromthrough dates of the claim. The ub 04 is a claim form that is utilized for hospital services and select residential services. If there is only one digit in a field, enter a leading zero.

Choose from 16 different sets of hospital billing completing ub 04 claims flashcards on quizlet. The provider should contact mdhhs provider inquiry for answers to billing questions. Completing ub 04 claims 2nd edition by susan magovern, jean jurek and a great selection of related books, art and collectibles available now at. Inpatient services section ub tips ip in the part 2 inpatient services manual. Provider handbook 837 institutional ub 04 claim form. The electronic version of the ub 04 is called the 837i, the i standing for the institutional format. Diagnosis and procedure code qualifier icd version indicator. The ub04 paper claim form should be legibly printed by hand or electronically. Enter date of service for the charge line in mmddyy format. Third digit frequency 1 admission through discharge. Ub04 handbook for hospital billing, with answer key. September 2020 education and counseling visit with a physicians assistant pa in this example, a female client, who is a depo medroxyprogesterone acetate dmpa user, is coming in for concerns with bleeding. A primary payer b secondary payer c tertiary payer.

The professional component will be billed on the cms1500 claim form like any other physician service. Understanding hospital billing and coding 9781455723638. The format of the threedigit code is indicated below. Highmark requires facility providers to bill electronically via 837 institutional 837i electronic transactions. Ub 04 instructions the blocks divided into rows a, b, c reflect the following. The following facility claim ub 04 data elements are necessary to correctly bill interim claims. Chapter 25 completing and processing the form cms1450 data set.

Total health care is required by state and federal regulations to capture specific data regarding. Uniform claims and billing form reporting manual november 2020 page 3 of 187 inpatient ub 04 data reporting overview background the pennsylvania health care cost containment council phc4 is an independent state agency formed under pennsylvania statute act 89 of 1986, and amended by act 15 of 2020. It describes how hospitals are reimbursed for patient care and services, showing how the ub 04 claim form. Ub04 handbook for hospital billing, without answer key. Ub04 special billing instructions for inpatient services ub. A basic guide to hospital billing and reimbursement understanding hospital billing and coding 3rd edition helps you understand complete and submit the ub 04 claim form that is used for all medicare and privately insured patients. August 2020 this section includes information about by report attachments to claims, fromthrough billing and submitting claims for treatment authorization requestapproved procedures. Part 2 ub04 special billing instructions for inpatient services page updated. Second digit classification 1 hospice non hospital based 2 hospice hospital based c.

Ub 04, inpatient outpatient hospital inpatient and outpatient, hospice, home health, rural health clinic, federally qualified health center, and birthing center must bill on a ub 04. No other publication governmental or privatecommercial can be considered authoritative. Hospital service claims are typically submitted electronically or by using a nationally recognized billing form called the ub 04 short for uniform bill 2004, sometimes referred to as the cms1450 form. Mo healthnet paper claims for hospital inpatient care are mailed to. A reference and training tool for the ub 04 manual. It describes how hospitals are reimbursed for patient care and services showing how the ub 04 claim form reflects the flow of patient data from the time of admission. If a nondrg claim is billed as an interim bill, the patient status code submitted is 30 still a patient, and no discharge date is entered on the claim. A basic guide to hospital billing and reimbursement, understanding hospital billing and coding, 3rd edition helps you understand, complete, and submit the ub 04 claim form that is used for all medicare and privately insured patients.

A treating physician or hospital may issue an identification notice. Ub04 billing instructions for long term care claims. Filing medicare part a crossover claims on the ub 04. Instructions for completion are the same for inpatient and outpatient claims unless otherwise noted.

Understanding hospital billing and coding 3rd edition. Ub 04 claim form instructions ak provider billing manuals. The ub 04 cms 1450 is a claim form used by hospitals, nursing facilities, inpatient, and other facility providers. The following table can be found in ub04 tips for billing. Ub 04 hospital bill fill out and sign printable pdf. The ub 04 is the red ink on white paper standard claim form used by institutional providers for claim billing. Hipaa compliant ub claim submission is also available in navinet. The following instructions explain how to complete the ub04 claim form and whether a field is required, required if applicable, or not required. Enter the name and address of the hospital facility submitting the claim. Ub 04 claim filing instructions inpatient hospital.