Smaller facilities all over the country are finding insurance claim billing to be more and more difficult. There are more and more companies out there providing facility services to patients but are not able to bill them correctly – facilities like outpatient (or residential) drug and alcohol treatment facilities, laser surgery centers and eating disorder clinics. Most facility services must be filed on UB04 forms and these companies either don’t understand billing – period, or are only familiar with CMS 1500 billing. Many billing services stay away from them because they require the UB04 form and most PM (practice management) systems don’t allow for billing on UB04’s.
Many of these facilities tend to be out of network with most insurance carriers. Some insurance policies will still pay out of network so patients are finding that they can get their claims paid if they can get them submitted on a UB04 form. But the catch 22 is that the facilities aren’t billing on UB04 forms and don’t know how so they can’t help the patient. We are seeing more facilities now looking into trying to help these patients and even getting into network with some of these insurance carriers.
Billing on the UB04 form is not as difficult as it seems. We were first contacted years ago by the owner of a drug and alcohol facility who was not receiving payments because his staff was unable to file claims on UB04 forms, and we had never completed them either. But Alice having the utmost confidence in me and somehow thinking that my degree in computer programming somehow broadly covered this subject, assured him we could handle the job.
WHATTTT!!!! Ok, so it was early in our career and it was a very good account to get, so what did we do? We learned how to fill out the UB04 form. There was one book available at the time, it was very large, and very expensive. We bought it and I waded thru a ton of info that didn’t pertain to smaller, outpatient facilities to find what I needed to know, then I reprogrammed our practice management system to be able to print the UB04 forms.
Piece of cake! Yeah, it wasn’t all that easy.
But the good news is there are other alternatives now, and it is truly not that bad! Back then there wasn’t a lot of info or help. But now, there is.
After receiving many requests for help on billing with UB04’s we decided to write a shorter, (lighter!) much easier to read and understand manual for
others on completing a UB04 form. Here is more information on completing a UB04 form.
We also found a company that created a UB04 form filler at a very reasonable price ($259 onetime cost). It is very easy to type the info into the form filler and print out the claim. You can save the claim in case you have to reprint it later. If you already have a PM system you can use that to track the claims and just submit using the fill and print. It does involve double entry but between our UB04 book and the form filler you can now submit facility claims with a pretty good chance of getting them paid.
The fill and print we use from Speedy Soft can be found at Speedy Soft.
It’s actually quite user friendly and does store data. It’s very quick and easy to create the UB04 form and you can even submit the claims electronically.
We use the fill and print to create the claim, file electronically, and then we input the information into our PM system for tracking purposes. It works quite well. These facilities can be very good clients for a billing service, and they usually find that outsourcing works well for them. They don’t usually have the staff or the staff doesn’t have the knowledge to handle the UB04 billing. Once you learn how to complete the UB04 form, the rest is basically the same as professional billing. Tracking the claim, making sure payment is correct, following up on denied or unpaid claims, etc. You may find that one insurance carrier requires a different type of bill (box 4 on the UB04 form) than another carrier, but you adjust.
Facility billing may be a great avenue for a billing service to pursue to either get their business started, or expand. UB04 form billing can be learned, and is not a difficult as it may seem. Different form, different fields, same concept. If you are looking to expand, and you are not afraid of adventure, give it a try!