| Resources > UB-04 Forms & Publications |
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Full color paper proofs of the UB-04 form are available from:
New Medical Forms
Sales & Customer Support
Email: newmedicalforms@pacbell.net
Phone: 1-877-256-0027
Website: www.newmedicalforms.com
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The Official UB-04 Data Specifications manual is available from the National Uniform Billing Committee (NUBC). Cost is $150/year for an electronic manual which is printable, as well as an electronic version with updates.
- Send your request via mail: American Hospital Association, National Uniform Billing Committee, P.O. Box 92247, Chicago, IL 60675-2247
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UB-92 and/or UB-04 Handbook for Hospital Billing
Visit: www.aha.org. Then, scroll to the bottom of page, click on AHA ONLINE STORE and search for BIRKENSHAW or BILLING in the product search box. |
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CMS has released its report to Congress about RAC activities for FY 2010. The results are a mixed bag. Here are some highlights:
- There were $92.3 million in identified and corrected improper Medicare payments.
- Over half of the recovered overpayments were from inpatient claims ($41 million).
- The average overpayment recovered was $408.
- The RACs identified and demanded repayment of $136 million in repayments, so there is still $61 million, or 45% of the indentified overpayments, to be recovered.
- Providers only appealed 8,000 claims, which is only about 5% of the identified overpayments. They prevailed in half of the appeals.
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HIMSS completed its 3rd survey assessing 5010 readiness among healthcare stakeholders in December 2010. Some of the results were reported during the multi-collaborative "GetReady5010.org" webinar that attracted more than 18,000 registrants.
Below is the power point presentation used for the Webinar series (organized by HIMSS, WEDI, HBMA, AHIMA and others), followed by a detailed analysis prepared by the past chair of our Medical Banking and Financial Systems Committee, Joe Miller:
PPT Presentation >>>
Analysis >>>
For more information on this survey, go to: http://www.mbproject.org/TheHIMSS5010ICD-10Survey.php |
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Report: Medicare Fee-for-Service Recovery Audit Program
as of March 2011
In accordance with Section 306 of the Medicare Prescription Drug, Improvement and Modernization Act of
2003 (MMA), CMS conducted a Recovery Audit demonstration from March 2005 to March 2008. The U.S
Congress authorized the nationwide expansion of the Recovery Audit program through the Tax Relief and
Health Care Act of 2006. Recovery Auditors are CMS contractors who are tasked with detecting and
correcting past improper payments.
For more information, download the complete CMS report here:
http://www.cms.gov/RAC/Downloads/FFSNewsletter.pdf
Report: Physician/Non-Physician Practitioner Additional Documentation Limits
As of 2/14/11, CMS modified the physician/non-physician practitioner additional documentation request (ADR) limits for the RAC program.
The limits will be based on the servicing physician or non-physician practitioner's billing Tax Identification Number (TIN), as well as the first three positions of the ZIP code where that physician/non-physician practitioner is physically located.
For example: ADR limits will be based on the number of individual rendering physicians/non-physician practitioners reported under each TIN/ZIP combination in the previous calendar year.
For more information, go to:
http://www.cms.gov/RAC/Downloads/PhyADR.pdf |
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(5/27/2010) Legislation has recently announced a bill that would close the 72-hour rule loophole that allows re-billing. The effective date is unknown at this point to the public. The name of the amendment is the American Jobs & Closing Tax Loopholes Act of 2010; HR 4213. |
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CLICK FOR DETAILS >>> |
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(5/10/2011) Medicare Contractors will automatically deny claim line(s) items submitted with a GZ modifier, effective for dates of service on or after July 1, 2011.
Further, your Medicare contractor will not perform complex medical review on any claim line item(s) submitted with the GZ modifier. |
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CLICK FOR DETAILS >>> |
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(5/10/2011) Make sure your billing and coding staffs are aware of these changes and properly code the POA Indicator on every claim. Upon implementation of version 5010 of the 837I electronic health care claim, providers will no longer have the ability to report the End of POA indicator. |
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CLICK FOR DETAILS >>> |
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This is a new Medicare Learning Network (MLN) educational
newsletter, entitled the "Medicare Quarterly Provider Compliance Newsletter." CMS' goal with this informational newsletter is to help physicians, providers, and suppliers and their billing staffs avoid billing errors and other harmful activities when working with the Medicare Fee-For-Service (FFS) program.
Download the latest issue here from July 2011: http://www.cms.gov/MLNProducts/downloads/MedQtrlyComp_Newsletter_ICN903687.pdf
Download the third issue here from April 2011: http://www.cms.gov/MLNProducts/downloads/MedQtrlyComp_Newsletter_ICN903696.pdf
Download the second issue here from February 2011: http://www.cms.gov/MLNProducts/downloads/MedQtrlyComp_Newsletter_ICN905712.pdf
Download the first issue here from October 2010 (see pages two & six for billing issues): http://www.cms.gov/MLNProducts/downloads/MedQtrlyComp_Newsletter_ICN904943.pdf |
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NUCC Releases Annual Updated Version of the 1500 Claim Form Reference Instruction Manual
(July 12, 2011) The National Uniform Claim Committee (NUCC) has released its annual, updated version of its 1500 Health Insurance Claim Form Reference Instruction Manual. The updated instruction manual, Version 7.0 7/11, goes into effect immediately and is available at the NUCC's website, www.nucc.org, under the 1500 Claim Form tab. A complete list of the changes is also available on the website.
Any interim changes, clarifications, or corrections to the instructions following this release will be posted on the NUCC website.
The 1500 instruction manual is maintained by the NUCC. The NUCC is a voluntary organization of health care industry stakeholders representing providers, payers, designated standards maintenance organizations, public health organizations, and vendors. Additional information about the NUCC is available on its website.
For more information on the 1500 Health Insurance Claim Form Reference Instruction Manual, visit the NUCC website or email info@nucc.org |
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Uniform billing (UB-04) implementation. Here is the link to the manual:
http://www.cms.hhs.gov/transmittals/downloads/R1104CP.pdf |
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The Medicare Learning Network (MLN) Matters is a database of national educational articles by the CMS, in consultation with expert clinicians, billing experts, and CMS subject matter experts. The articles are designed for physicians, providers and the supplier community and feature the latest changes to the Medicare Program.
You will see a wide array of articles-each specifically writer for the provider that is affected by multifaceted Medicare changes. MLN Matters' hope with its educational articles it to reduce the implementation time of these Medicare changes.
General Information and MLN Matters Article Index: http://www.cms.gov/MLNMattersArticles/
Uniform Billing (UB-04) Implementation - UB-92 Replacement: http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5072.pdf |
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National Drug Codes (NDC) Codes will be required on UB claims when drugs given have a rebate if Medicaid is the primary or secondary payer (listed in FL 50 A or FL 50 B). On July 9, 2007 CMS' released its final rule with a comment period related to listing NDC codes on hospital outpatient claims, effective October 1, 2007.
There is concern that hospitals will not be able to meet the requirements of the regulation. The attached 587-page document clarifies the ruling as well as listing names and addresses for people to write and send comments. If you are concerned, please act now!
For more information, click on the button below for the PDF document:
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Briefly, providers must obtain their NPI numbers as well as the NPI number of other providers they interact with. Providers may report the NPI as well as the legacy number, or the legacy number if working towards compliance. Up until 5/23/08,
CMS will not impose penalties on covered entities that deploy contingency plans to facilitate the compliance of their trading partners. See the MedLearn Matters article and the CMS change request related to NPI. For more information, click on the buttons below for a PDF document:
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POA indicators must be reported for inpatient acute care hospital discharges as of October 1, 2007. See below for the CMS MedLearn Matters article and the Change Request Transmittal manual.
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NDC Codes may now be required on UB claims. Please act now. On July 9, 2007 CMS' released its final rule with a comment period related to listed NDC codes on hospital outpatient claims. There is concern that hospitals will not be able to meet the requirements of the regulation.
For more information, click on the button below for a PDF article:
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In July, 2007, CMS released MedLearn Matters SE0725 with additional NPI information. They are asking providers to send a small number of claims with only the NPI.
For more information, click on the button below for the PDF article:
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Visit the Washington Publishing Company Website: www.wpc-edi.com |
