FL74: Main Procedure Code/Date – ICD-10 PCS for the main procedure performed during the period covered by the invoice and the date on which the main procedure described on the invoice was performed. In the case of IV therapy services at home and in hospital, if the operation is performed during the hospital stay from which treatment is initiated. Form UB-04 is used by institutional providers such as nursing homes and hospitals, while Form CMS-1500 is the standard application form used by a non-institutional provider or provider such as a physician or durable medical device provider. FL77: Operator Name/CPD – Person with Primary Responsibility for Performing the Surgical Procedure To complete the form correctly and completely, be sure to do the following: While Form UB-04 is primarily for institutional providers to bill insurance companies, it`s never a bad idea to educate yourself about what goes into medical claims. If you see something you don`t understand, ask your insurer or provider to explain it to you. Forms CMS-1500 and UB-04 contain many of the same fields that need to be completed, including patient demographics, provider identification information, procedures and fees, and insurance plan credentials. The more information you can provide to the patient`s insurance company, the better. It is important to include information, such as when the first event started, whether it was repeated or occurred, whether it was related to an accident, etc. Also, be sure to always double-check the accuracy of any claims for coding. Unfortunately, there can still be grey areas as to the form required. While CMS-1500 and UB-04 forms help process a patient`s medical claim, the insurance company reimburses services and denies the claim if it doesn`t meet their criteria. If you still have questions about these forms, the friendly representatives at StrataPT can help.
Backed by our 100% US-based customer support, we are the leading enterprise operating system for PT/OT practices in the US, offering proprietary solutions focused on easy integration, revenue cycle management, and transparent patient reporting. FL80: Notes – additional information required to decide applications Although these forms are similar, they can NOT be used interchangeably. You will quickly find that Form UB-04 has more than twice as many fields as the CMS-1500. Indeed, hospital billing has many more codes and services in its complex system. What is the difference between CMS-1500 and UB-04 forms? This is a question that seems to be thrown around a lot, so we`ll break down each form in this guide to determine how and when each should be used. For more information on billing processes, see the Billing Guide for Physiotherapists. The form would be used for surgery, radiology, laboratory or other institutional services. This form is used to file fees under Medicare Part-A. The UB-04 Unified Medical Billing Form is the standard claim form that any institutional provider can use for the settlement of inpatient or outpatient medical and psychiatric claims. This is a paper claim form printed in red ink on standard white paper. Although developed by the Centers for Medicare and Medicaid Services (CMS), the form has become the standard form used by all insurance companies. FL53: Asg.
Benedict. – This field indicates whether the provider has a signed form authorizing the liability insurer to pay the provider directly for the service. This indicator applies to payers listed in FL50 on lines A, B and C. Form CMS-1500 consists of 33 items to complete the details necessary for the purposes of the claim. Examples of elements of CMS-1500 include: The National United Billing Committee (NUBC) is a voluntary, multidisciplinary committee that develops data elements for claims and transactions. The NUBC is responsible for the design and printing of Form UB-04. There are 81 fields or lines on a UB-04. They are called shape locators or “FLs”. Each form locator has a unique purpose: as of 2007, the UB-04 replaced the UB-92.
The AHA (American Hospital Association) and the NUBC (National Uniform Billing Committee) monitor and monitor the use of UB-04 to ensure it is up-to-date and equally useful for patients, medical providers and insurance companies. UB-04 is the application form for institutional institutions and includes: Centers for Medicare and Medicaid Services. Professional Paper Claim Form (CMS-1500) A detailed medical invoice details all the services provided during a visit or stay – such as a blood test or physical therapy – and can be sent directly to the patient. Form UB-O4 is used by institutions to bill Medicare or Medicaid and other insurance companies. FL74 A-E: Other Procedure Codes and Data – This field is used to report up to five ICD-10 PCS to identify the essential procedures performed during the accounting period, excluding the main procedure, and the corresponding dates on which the procedures were performed. Report those that are most important for the treatment episode, and especially any therapeutic procedure closely related to the primary diagnosis. In the case of IV therapy services at home and in hospital, if the operation is performed during the hospital stay from which treatment is initiated. Enter the codes in these fields in descending order of importance. This is the standard health insurance claim form used to file medical and professional claims with Medicare providers. In other words, the CMS-1500 is used for individual claims from providers and is used to file fees under Medicare Part-B. Although the CMS-1500 and UB-04 forms may seem similar, they are very different and have different purposes. Therefore, the two forms cannot be used interchangeably.
First, let`s look at each form and see why they differ in their functions. Form UB-04 (CMS-1450) is the application form for institutional institutions such as hospitals or ambulatory facilities. This includes things like surgery, radiology, laboratory, or other facility services. Form HCFA-1500 (CMS-1500) is used to file fees that fall under Medicare Part B. UB-04 (CMS-1450) is to lay charges under Part A of Medicare. The Centers of Medicare and Medicaid Services points out that “Form CMS-1450 can be used by an institutional provider to bill a Medicare tax intermediary (FI) if a provider qualifies to waive the Administrative Simplification Compliance Act (ASCA) requirement for electronic filing of claims. It is also used to bill institutional fees to most state Medicaid agencies. “Although the CMS-1450 form is based on the CMS-1500 form, there is a big difference when it comes to their use. This is because hospitals or institutions may not charge fees for procedures, but doctors charge procedures to get compensation. Therefore, CMS-1500 is used only by doctors. However, facilities where insured patients receive treatment must also be reimbursed to maintain a healthy income cycle. Therefore, these institutions use Form CMS-1450 with 81 field tracking devices to provide all necessary details such as HCPCS, NPI, tax number, etc.
Forms UB-04 and CMS-1500 are designed and maintained by the National Uniform Claim Committee (NUCC). Both forms are used for refund purposes, but these forms tend to vary in terms of usage.