Author Topic: UB-04 completion  (Read 2236 times)

dedwards

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UB-04 completion
« on: April 30, 2009, 04:55:55 PM »
I would really appreciate any help any of you could offer me!  I am desperate!  We are trying to get set up through our software company to electronically send claims to Medicare.  According to our software company, I am responsible for telling them what goes into the "fields" of the UB-04 form.
What further complicates matters is that I work for a community mental health facility and will be filing for partial hospitalization charges for Medicare Part A.  I have printed out everything I can find on the internet (including a 126 page Medicare Claims Processing manual), but I feel like I'm working a puzzle without the correct pieces!
Thank you very much.
Debbie

Pay_My_Claims

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Re: UB-04 completion
« Reply #1 on: April 30, 2009, 06:42:43 PM »
are you needing help on what to tell them?? Which Fields?

dedwards

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Re: UB-04 completion
« Reply #2 on: May 01, 2009, 10:40:27 AM »
The main fields I'm puzzled about are the value codes, and the occurance span (since we see partial hospitalization clients on an ongoing basis - they come 5 days per week for this program).  I'm unsure if I'm correct about a couple more, but I think I understand them somewhat.
Also, the manual contradicts itself about the entire PHP program which is only mentioned twice in the entire manual!
I think our situation is so unique is why I'm having such problems.  We are the only for-profit mental health facility which has a partial care program in the entire state as far as I can tell.  ICD/CPT - what to put in the blanks, I'm fine.  It's just the fields to be set up that's making me pull my hair out!
Thank you for any help you can offer!
Debbie

PTBILLER

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Re: UB-04 completion
« Reply #3 on: May 01, 2009, 06:43:53 PM »
Hi there-It's been a looonnngg time since I've worked with a facility and therefore filling out a UB92 form.  Try this link and see if this will help http://www.cms.hhs.gov/Transmittals/downloads/R1104CP.pdf
Pam McKewen

Denise35

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Re: UB-04 completion
« Reply #4 on: May 03, 2009, 02:43:41 AM »
Hello Dedwards,

Medicare Part A billing is a little unique but holds the same principle as the hcfa 1500 billing but in a different formaility.  The values codes are codes detailing to Medicare how many days you are billing seeking full payment, copay days, and even noncovered days (if appliable).

Occurrance Span is a detailed matter as well and needs to be understood in order to get the claim paid.   It details the length of stay which qualifies the claim for part A payment and additional dates of additional services/procedures the patient may have incurred in additional to the inpatient stay which may be a payable service/procedure separately by medicare.

All the fields you named have significant meaning/purpose and you need to clearly understand the meanings in order to optimalize billing. 

Initially for me when I was introduced to facility Part A billing, it threw me for a loop as well.  Its okay to be confused and frustrated.  That means you care, you want to learn, and have the desire to win the battle.  Just continue to seek out reliable guidance from Medicare and the available resources they offer for free.  With some trial and error, the lightbulb finally went off for me and it will for you.  You can do it! 

Recommendation: 

Please check with your carrier to see when the next webinar and/or local training session for facility billing which may includes how to complete the UB-04 for clean submission.  Perhaps you can ask questions if they don't touch on it (I always did).  Without completion of the information/fields required and necessary for payment, your claim will never leave the clearinghouse or pass your claim scrubber for processing.

I hope this helps and good luck,

Denise35

 
« Last Edit: May 03, 2009, 02:55:07 AM by Denise35 »
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dedwards

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Re: UB-04 completion
« Reply #5 on: May 03, 2009, 04:54:24 PM »
Thank you for your help and encouragement! 
Debbie

Pay_My_Claims

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Re: UB-04 completion
« Reply #6 on: May 03, 2009, 08:23:59 PM »

Please check with your carrier to see when the next webinar and/or local training session for facility billing which may includes how to complete the UB-04 for clean submission.  Perhaps you can ask questions if they don't touch on it (I always did).  Without completion of the information/fields required and necessary for payment, your claim will never leave the clearinghouse or pass your claim scrubber for processing.

I hope this helps and good luck,

Denise35

 

Great advise...Cigna Government Services just had one recently.