Facility billing is insurance policies billing for hospitals, inpatient or outpatient clinics, and other places of work these as ambulatory surgical procedure centers. This coverage billing is not the similar as billing for a regular medical professional or professional.
Facility billing is required to be submitted on UB04 varieties in its place of the more prevalent CMS 1500 varieties. The information necessary on UB04 varieties is various than the information necessary on the CMS 1500.
For instance, UB04 sorts require rev codes and a style of monthly bill code that are not demanded on the CMS1500 variety. There are also a good deal of “conditional fields” that for most cases are not needed to be finished. It is essential that you know how to full the UB04 kind appropriately in buy to get reimbursed adequately from the insurance policies carrier.
Some places of work could monthly bill as each facility and specialist billing. We invoice for an outpatient drug and liquor rehab facility that is owned by an LCSW. Some insurance policy carriers have it credentialed as a facility and demand the billing to be done on UB04 kinds. This is advantageous to our shopper simply because the facility reimbursement fee is better than the professional reimbursement fee. But other insurance coverage carriers will not credential him as a facility and he must monthly bill services out to them on CMS1500 sorts as frequent treatment visits.
So you may possibly uncover you in a place the place you have to have to invoice out on equally the UB04 and the CMS 1500 kinds. In any scenario, it is vital that you are completing the sorts correctly.
When we first acquired how to post UB04 varieties, they had been actually continue to the aged UB92 varieties. We had to order a reserve named the UB92 editor which is a extremely thorough guide on what all the fields on the UB92 kind are for. It was helpful, but it basically contained way too substantially info. The ebook is hard to navigate and is truly very pricey. The information in it is expected if you are executing in depth inpatient billing, but for the littler dude, this kind of as outpatient clinics, it is too a great deal facts and much too difficult to decipher. We get tons of thoughts from people today who are hoping to total a UB04 type correctly.
In purchase to total the UB04 varieties accurately for facility billing, it is quite significant to fully grasp the dissimilarities in billing strategies in between the CMS 1500 types and the UB04 types. Make guaranteed your claims are paid correctly the 1st time they are submitted.
Copyright 2007- Michele Redmond