Facility Billing

Billing for facilities is much different than professional billing, or billing for individual doctors or groups of doctors.  Facilities include drug and alcohol rehab, eating disorder clinics, and much more. Billing for facilities is usually done on UB04 forms rather than CMS 1500 forms.  UB04 forms are entirely different than CMS 1500 forms and require different information than CMS forms.

UB04 forms require REV codes, type of bill, source of admission, condition codes and more.  If you are currently billing for primary care doctors and for specialties like physical therapy or mental health, you will have a lot to learn in order to bill for a facility.  UB04 forms in themselves can be a bear to complete properly, but besides that, individual insurance carriers will often insist that claims to their company be billed differently.

They may require a different REV code than the norm.  They may require that services be billed as HCPCs codes on a CMS 1500 form instead of as REV codes on a UB04.  Each carrier may have a completely different set of billing guidelines.  Because of this facility billing tends to be a lot more involved than professional billing.  The important thing is to develop communication with each insurance carrier, find out their requirements and be diligent to get the claims filed in the manner that is required.

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