Facility billing is insurance billing for hospitals,
inpatient or outpatient clinics, and other offices such as ambulatory
surgery centers. This insurance billing is not the same as billing for a
regular doctor or specialist.
This billing is required to be
submitted on UB04 forms instead of the more common CMS 1500 forms. The
information required on UB04 forms is different than the information
required on the CMS 1500. Here is more information on
completing a UB04 form
correctly.
For example, UB04 forms require rev
codes and a type of bill code that are not required on the CMS1500 form.
There are also a lot of "conditional fields" that for most situations are
not required to be completed. It is important that you know how to
complete the UB04 form correctly in order to get reimbursed properly from
the insurance carrier.
Some offices may bill as both facility
billing and professional billing. We bill for an outpatient drug and
alcohol rehab facility that is owned by an LCSW. Some insurance carriers
have it credentialed as a facility and require the billing to be done on
UB04 forms. This is beneficial to our client because the facility
reimbursement rate is higher than the professional reimbursement rate. But
other insurance carriers will not credential him as a facility and he must
bill services out to them on CMS 1500 forms as regular therapy
visits.
So you may find yourself in a position where you need to
bill out on both the UB04 and the CMS 1500 forms. In any case, it is
crucial that you are completing the forms correctly.
When we first
learned how to submit UB04 forms, they were actually still the old UB92
forms. We had to purchase a book called the UB92 editor which is a very
detailed book on what all the fields on the UB92 form are for. It was
helpful, but it actually contained too much information. The book is hard
to navigate and is actually quite costly. The information in it is
required if you are doing in depth inpatient billing, but for the littler
guy, such as outpatient clinics, it is too much info and too difficult to
decipher. We receive tons of questions from people who are trying to
complete a UB04 form properly.
