|UB-04 Handbook for Hospital Billing, With Answer Key: A Reference and Training Tool for Efficient Operations in Health Care Facilities|
Claudia Birkenshaw, M.S.A.
Publisher: American Hospital Association
The first textbook that helps HIM professionals and students understand the differences between the UB-04 and the UB-92 and provides a global view of how the billing function should work in conjunction with the coding department. The Handbook provides accurate and timely information about the UB-04 and explains how and why ICD-9, CPT and HCPCS code conventions must be integrated with UB-04, HCFA-1450 and CMS-1450 billing conventions. The book can be used toteach an individual how to complete a facility UB-04 billing form, and contains vignettes that explain the billing office process, its components and reporting nuances. It will help HIM staff understand that coding conventions for billing are as important as ICD-9 coding conventions when sending a claim to an insurance company or payer and ensure that members of other departments (e.g., accounting, admitting, quality management) understand how their indispensable contributions to the revenue cycle must be translated by billers to fit changing UB-04 Form Locator codes.The book contains an overview of basic payment methodologies, plus 65 quizzes that can be used for self-testing, for performance evaluations or classwork assignments.
This book will help hospitals and other health care providers maximize claim processing performance and revenue recovery and better manage their revenue cycle process
A training manual for facility billing, charging, and reimbursement in:
- Skilled nursing facilities
- Durable medical equipment agencies
- Behavioral health & chemical treatment agencies
- Surgery centers
- Ambulatory surgery centers
- Subacute and LTC facilities
- Hospice organizations
- Health Plans
NUBC Recognition and Support
The National Uniform Billing Committee (NUBC)—the official group representing provider and payer organizations formed to develop a single, nationwide billing form and standard data set—has been actively involved in the UB-04 Handbook development. The Handbook format and content is designed to work with the NUBC UB-04 Data Specifications Manual, a manual that identifies the national requirements for preparing insurance claims and contains the latest codes, changes in code definitions, and coding issue clarifications. It is an integral part of HIPAA standards.
UB-04 Handbook Learning Objectives
- Explain the background and development of the National Uniform Billing Committee (NUBC) and the development of the country’s universal facility billing form, the UB-04, and realize the massive difficulties facing the country’s health care providers and the complex issues surrounding payment and reimbursement.
- Understand the UB-04, its format, and its billing conventions as well as the various revenue codes and form locators, their definition and purpose, and other codes, including type of bill, condition, occurrence, and value codes.
- Assimilate and process a claim by correctly entering codes (including diagnosis, procedure, and revenue codes); charges; and demographic, payer, and provider information onto a UB-04.
- Comprehend the variety of requirements by various health plans, the data needed for billing each type of payer, and the diverse payment methodologies. Insurers discussed in this handbook include Medicare, Medicaid, Blue Cross, commercial insurance carriers (such as United Health Care, CIGNA, and Aetna), managed care organizations, TRICARE, and workers’ compensation.
- Understand aggregate billing techniques for inpatient claims versus line-item outpatient claims.
- Complete the skill exercises throughout the various chapters.
- Explain specific billing structures, revenue codes, value codes, occurrence codes, and other data for common services such as:
- Outpatient diagnostic procedures (X rays, laboratory tests)
- Ultrasound, MRI/MRA, CT scans
- Emergency room
- Outpatient cardiology procedures, such as heart catheterization
- Outpatient surgical and GI lab procedures (endoscopic procedures such as colonoscopy or bronchoscopy)
- Outpatient therapies (physical, speech, occupational)
- Inpatient services (medical, surgical, obstetrics, newborn, rehab)
- Services by other providers who use the UB-04, including skilled nursing facilities, home health agencies, hospices, and ambulance services.
- Assimilate reasons why claims are rejected and understand some techniques for follow-up (rebilling), including the vast set of issues related to managed care contracts, such as securing authorizations and precertifications.
- Learn about health care payment structures, copays, deductibles, explanation of benefits, remittance advice, contractual adjustments, and payment vouchers.
- Define the role and responsibilities of hospital/facility insurance billers, patient accounting specialists, and such related staff as admitting, patient access, registration, patient intake, scheduling, health insurance management/medical records, physicians, case management/utilization review/quality review, and information services.
- Interpret common hospital financial terminology and abbreviations.
- Explain the patient accounting specialist’s role in confidentiality, fraud/insurance abuse, and compliance issues
- Understand how billing information is captured by clinical computer systems and passed on to the hospital financial/billing system (the charge master), and how the codes link to the UB-04 for billing, including an understanding of financial classes, patient types, insurance payer codes, and transaction codes.
- Comprehend the Medicare payment program
- Review modifiers used on the UB-04.
- Appreciate the complexity of the country’s health care reimbursement system, payer and employer initiatives, and the various roles of patient financial services departments.
Table of Contents