History of Medical Billing and the UB-04 Form

In 1975, in an effort to simplify healthcare billing in the U.S. and develop one standard, nationally-accepted billing form, the American Hospital Association brought together all national payer and provider organizations and developed the National Uniform Billing Committee (NUBC).

After years of technical data and policy debate, in 1982 the NUBC voted to accept the UB-82 and its associated data manual for implementation as a national uniform bill.

Predecessors to the UB-82 included the:

  • UB-16-78 – Field-tested by five states in the 1970s
  • UBF-1 – The uniform bill used in New York State

Once the UB-82 format and data specifications were finalized and adopted, focus moved to individual states for implementation. As a result, the State Uniform Billing Committees (SUBC) were created to disseminate UB-82 manuals and oversee unique state billing requirements.

History of Medical Billing, Coding and the UB04 Form

History of Medical Billing and the UB-04 Form (continued)

After an eight-year moratorium on changes to the UB-82, NUBC oversaw numerous state surveys in an effort to implement improvements on the UB-82 design.  As a result, the UB-92 was created incorporating the best of the UB-82 along with needed improvements on the data set design.

Again, more changes were needed. Thus, following a four-year study involving NUBC members and various public surveys, the UB-04 was approved as the new form starting March 1, 2007 and mandated May 23, 2007. The UB-92 paper claim will not be accepted, even as an adjustment claim after May 22, 2007.

NUBC was named as a prominent role player in the final regulations from the Health Insurance Portability and Accountability Act and helped define data content for each of the electronic transactions mentioned in the legislation.
History of Medical Billing and Coding

Form Locator 15 Point of Origin

Starting July 1, 2010 there were significant changes elminated in UB-04 data collection for Point of Origin (PoO) code 7 (from ER). Most people are not aware that the NUBC made a significant change in data collection regarding patients who are admitted after being seen in the ER. Currently, hospitals list code 7 when patients are admitted after being seen in the ER.

However, that will change since Code 7 is eliminated as of July 1, 2010. Instead, when patients are admitted, the hospital will assign the "code" where the patient originated from, such as the nursing home, private residence/home, etc. This significant change is being made for several reasons. Overall, code "7" did not follow or match the overall intent of the other codes within that code set. Also, with quality reporting issues more important, eliminating code 7 addresses other issues.

PoO Code 7 being deleted may affect:

  • HIM/Inpatient coders.
  • Data collection.
  • Multiple systems & their interfaces. Review your claim scrubber - hospitals may have built edits on Code 7 - "If FL 15, Source of Admission, is code 7, then..." or other variations.
  • Billers who are accustomed to see code "7" when patients are admitted after being seen in the ER.

At a conference call in early November, NUBC also assigned condition code P7 for state reporting requirements, that code explains that the patient was admitted after being seen in the ER. This code is effective 1/1/2011 since it was too late to meet CMS' deadlines to allow it sooner.

Point of Origin Code B - transfer from another home health agency - has also been deleted, effective 7/1/2010. A new condition code 47 is now used, effective the same date. Point of Origin Code C - readmit to the same home health agency - has also been deleted, effective 7/1/2010.


Definition of the UB-04 Form

In 1975, in an effort to simplify healthcare billing in the U.S. and develop one standard, nationally-accepted billing form, the American Hospital Association brought together all national payer and provider organizations and developed the National Uniform Billing Committee (NUBC).

After years of technical data and policy debate, in 1982 the NUBC voted to accept the UB-82 and its associated data manual for implementation as a national uniform bill. Predecessors to the UB-82 included the:

  • UB-16-78 – Field-tested by five states in the 1970s
  • UBF-1 – The uniform bill used in New York State

Once the UB-82 format and data specifications were finalized and adopted, focus moved to individual states for implementation.  As a result, the State Uniform Billing Committees (SUBC) were created to disseminate UB-82 manuals and oversee unique state billing requirements.

The definition of the UB-04 Form