It used to be that only hospitals and ambulatory surgery centers were considered facilities and needed to file their claims on UB04 forms. But there are many other providers that are also classified as facilities that are now being required to file their claims on UB04 forms as well.
Many out patient drug and alcohol rehabilitation providers are classified as facilities. In the past they were allowed to file claims on CMS 1500 forms. Recently we are seeing a trend where more and more insurance carriers are requiring these providers to now bill on facility claim forms, or UB04’s.
This presents a problem for these smaller ‘facility’ providers. They do not usually have a professional biller or coder on staff. The person, or people who have been doing their billing have no experience with UB04 forms and don’t know what a rev code is. Some start out thinking it can’t be that much different, but in reality UB04’s and CMS 1500’s are very different.
The UB04 form requires rev codes and a type of bill along with the CPT codes that are used on the CMS form. The format of the UB04 is totally different as well. It is important that you know exactly which fields need to be completed and what information goes in them. We most commonly see denials for incorrect type of bill.
Another problem is that most practice management systems do not come with the capability to print UB04’s. So how do you get the computer to print them out? If you are lucky, your practice management system will allow you to print a UB04, but unfortunately that is not the norm. So you have to find another way. There are some inexpensive UB04 fill and print softwares out there, but that means double entry. You have to put the data in the UB04 software to print the form, and you have to enter it into your practice management system to track the claim. Still this is a reasonable option for some.
Many others fill the forms out by hand, or by typewriter. Personally, not an option for me. However, some carriers will not take handwritten forms anymore, so this may not work. Another way around this is to outsource the claims to someone with the capability of filing on UB04’s.
If you find yourself in a position where you need to switch over from CMS 1500 forms to UB04 forms the best thing to do is evaluate your situation and decide what will work best. If you are capable of filing the forms yourself, then become familiar with the UB04 form and how it needs to be completed. There are resources out there to help.
The PMBA (Professional Medical Billers Association) offers a course called Facility Billing 101 which covers all aspects of billing on the UB04 forms. The cost is only $99 for PMBA members and $129 for non-members. You can get more information here.