How the Outsourced Medical Billing Services Can Help You File UB-04 Forms?

 UB-04 form is considered to be one of the most significant claim submission forms in healthcare. It is employed by nursing facilities, hospitals, and rehab centers to file claims with insurance providers.

However, many healthcare providers don't have any idea about how this UB-04 form functions. It is often referred to as CMS-1450. Moreover, it is a highly structured and detail-driven form that is used to communicate all the services delivered by the providers to the patients.

Now, before delving into how the outsourced medical billing services can help you file the UB-04 form, let’s understand what the form is, its use cases, a detailed breakdown of the impatient and outpatient billing in UB-04 form, and finally, how the third-party billing companies can help you in this.

Defining UB-04 Claim Form

The healthcare providers use the UB-04 claim form to submit claims to:

• Medicare
• Medicaid
• Private insurance companies

The National Uniform Billing Committee (NUBC) has incorporated this form. They substituted the previous UB-04 form with the UB-92 form. Now, let's dive into the usage of this form.

Usage of UB-04 Form

The providers utilize UB-04 form to bill insurance providers for the rendered services. These forms are utilized for:

Hospital inpatient claims: These services incorporate:

• Nursing services
• Board and room
• Anesthesia fees and operating room
• Pharmacy and supply charges

Hospital outpatient claims: These services include:

• Same-day surgeries
• Observation stays
• Emergency department visits
• Outpatient labs, X-rays and MRIs

Skilled Nursing Facility (SNF) claims: The nursing facilities use this form to bill for specific services which includes:

• Daily RUG-based payment details
• MDS-related occurrence codes
• Revenue lines by service

Detailed Breakdown for Inpatient Versus Outpatient Billing in UB-04 Forms of 10 Field Locations

Field Location	Description	Inpatient	Outpatient
1	Provider Name and Address	Required	Required
2	Pay-To Name and Address	Situational	Situational
3a	Patient Control Number	Required	Required
3b	Medical Record Number	Situational	Situational
4	Type of Bill	Required	Required
5	Federal Tax Number	Required	Required
6	Statement Covers Period	Required	Required
7	Future Use	N/A	N/A
8a	Patient ID	Situational	Situational
8b	Patient Name	Required	Required
9	Patient Address	Required	Required
10	Patient Birthdate	Required	Required
11	Patient Sex	Required	Required
12	Admission Date	Required	Required, if applicable
13	Admission Hour	Required	Required, if applicable
14	Type of Admission/Visit	Required	Required
15	Source of Admission	Required	Required
16	Discharge Hour	Required	N/A
17	Patient Discharge Status	Required	Required
18-28	Condition Codes	Required, if applicable	Required, if applicable
29	Accident State	Situational	Situational
30	Future Use	N/A	N/A
31-34	Occurrence Codes and Dates	Required, if applicable	Required, if applicable
35-36	Occurrence Span Codes and Dates	Required, if applicable	Required, if applicable
37	Future Use	N/A	N/A
38	Responsible Party Name and Address	Required, if applicable	Required, if applicable
39-41	Value Codes and Amounts	Required, if applicable	Required, if applicable
42	Revenue Code	Required	Required
43	Revenue Code Description / NDC	Required, if applicable	Required, if applicable
44	HCPCS/Rates	Required, if applicable	Required, if applicable
45	Service Date	N/A	Required
46	Units of Service	Required	Required
47	Total Charges (By Rev. Code)	Required	Required
48	Non-Covered Charges	Required, if applicable	Required, if applicable
49	Future Use	N/A	N/A
50	Payer Identification (Name)	Required	Required
51	Health Plan Identification Number	Situational	Situational
52	Release of Info Certification	Required	Required
53	Assignment of Benefit Certification	Required	Required
54	Prior Payments	Required, if applicable	Required, if applicable
55	Estimated Amount Due	Required	Required
56	NPI	Required	Required
57	Other Provider IDs	Optional	Optional
58	Insured's Name	Required	Required
59	Patient's Relation to the Insured	Required	Required
60	Insured's Unique ID	Required	Required
61	Insured Group Name	Situational	Situational
62	Insured Group Number	Situational	Situational
63	Treatment Authorization Codes	Required, if applicable	Required, if applicable
64	Document Control Number	Situational	Situational
65	Employer Name	Situational	Situational
66	Diagnosis/Procedure Code Qualifier	Required, if applicable	Required, if applicable
67	Principal Diagnosis Code	Required	Required
67A-Q	Other Diagnoses Codes	Situational	Situational
68	Future Use	N/A	N/A
69	Admitting Diagnosis Code	Required	Situational
70	Patient's Reason for Visit Code	Situational	Situational
71	PPS Code	Situational	Situational
72	External Cause of Injury Code	Situational	Situational
73	Future Use	N/A	N/A
74	Principal Procedure Code/Date	Required, if applicable	Required, if applicable
74A-E	Other Procedure Codes/Date	Situational	Situational
75	Attending Name/ID/Qualifier 1G	Required	Required
76-77	Operating ID	Situational	Situational
78-79	Other Provider ID	Situational	Situational
80	Remarks	Situational	Situational
81	Code-Code Field/Qualifiers	N/A	N/A

As this form is a very complex process to manage, that’s why it can be a feasible option to hire a third-party medical service who can help you with this at a lesser cost.

How Can Outsourced Medical Billing Services Help You to Fill UB-04 Form?

• They provide expert coders: These billing experts know all the complex codes to streamline claim submission.
• Form locator accuracy: The billing specialists know all 81 form locators, which becomes difficult for the healthcare staffs to take note of, which reduces claim denials.
• They have payer-specific knowledge: The outsourced billing teams have knowledge of all the varying payer requirements to make a streamlined claim process.
• Automated data pull: The billing experts integrate with your clinic’s EHR to autofill patient and service details with ease.

The UB-04 form is very complex as it has different criteria and procedures. However, as the healthcare staff performs all the healthcare operations, that’s why it becomes difficult for them to provide quality patient care. That’s where the outsourced medical billing services come into the picture. These experts know all the complex coding nuances to streamline the claim submission process. Apart from that, they are also cost-effective compared to the in-house team as you don’t have to train them and provide separate office space for them. Hence, if you want to make sure all the claims are accurately submitted, you may consider outsourcing a third-party billing service.