Day 3: UB04 & Timely Filing
UB04 & Timely Filing
The UB-04 uniform billing form is the standard claim form that any Medicare Part A institutional provider can use for the billing of medical claims.
Who Can Bill Claims Using the UB-04?
- Community mental health centers
- Comprehensive outpatient rehabilitation facilities
- Critical access hospitals
- End-stage renal disease facilities
- Federally qualified health centers
- Histocompatibility laboratories
- Rural health clinics
- Skilled nursing facilities
- Home Health Agencies
- Indian Health Services facilities
- Organ procurement organizations
- Outpatient physical therapy services
- Occupational therapy services
- Speech pathology services
- Religious non-medical health-care institutions
Fields of the UB-04
There are 81 fields or lines on a UB-04. They’re referred to as form locators or “FL.” Each form locator has a unique purpose. However, Home Health will only, possibly, use 36 of these fields.
- Form locator 1: Billing provider name, street address, city, state, zip, telephone, fax, and country code
- Form locator 2: Billing provider’s pay-to name, address, city, state, zip, and ID if it’s different from field 1
- Form locator 3: Patient control number and the medical record number for your facility
- Form locator 4: Type of bill (TOB). This is a four-digit code beginning with zero, according to the National Uniform Billing Committee guidelines.
- Form locator 5: Federal tax number for your facility
- Form locator 6: Statement from and through dates for the service covered on the claim, in MMDDYY (month, date, year) format.
- Form locator 7: Not in use
- Form locator 8: Patient name in Last, First, MI format
- Form locator 9: Patient street address, city, state, zip, and country code
- Form locator 10: Patient birthdate in MMDDCCYY (month, day, century, year) format
- Form locator 11: Patient sex (M, F, or U)
- Form locator 12: Admission date in MMDDCCYY format
- Form locator 13: Admission hour using two-digit code from 00 for midnight to 23 for 11 p.m.
- Form locator 14: Type of visit: 1 for emergency, 2 for urgent, 3 for elective, 4 for newborn, 5 for trauma, 9 for information not available.
- Form locator 15: Point of origin (source of admission)
- Form locator 16: Discharge hour in same format as line 13.
- Form locator 17: Discharge status using the two-digit codes from the NUBC manual.
- Form locator 18-28: Condition codes using the two-digit codes from the NUBC manual for up to 11 occurrences.
- Form locator 29: Accident state (if applicable) using two-digit state code
- Form locator 30: Not in use
- Form locator 31-34 Occurrence codes and dates using the NUBC manual for codes
- Form locator 35-36: Occurrence span codes and dates in MMDDYY format
- Form locator 37: Not in use
- Form locator 38: Responsible party name and address
- Form locator 39-41: Value codes and amounts for special circumstances from the NUBC manual — 39=CBSA & 40=County
- Form locator 42: Revenue codes from the NUBC manual
- Form locator 43: Revenue code description, investigational device exemption (IDE) number, or Medicaid drug rebate NDC (national drug code)
- Form locator 44: HCPCS (Healthcare Common Procedure Coding System), accommodation rates, HIPPS (health insurance prospective payment system) rate codes
- Form locator 45: Service dates
- Form locator 46: Service units
- Form locator 47: Total charges
- Form locator 48: Non-covered charges
- Form locator 49: Page_of_ and Creation date
- Form locator 50: Payer Identification (a) Primary, (b) Secondary, and (c) Tertiary
- Form locator 51: Health plan ID (a) Primary, (b) Secondary, and (c) Tertiary
- Form locator 52: Release of information (a) Primary, (b) Secondary, and (c) Tertiary
- Form locator 53: Assignment of benefits (a) Primary, (b) Secondary, and (c) Tertiary
- Form locator 54: Prior payments (a) Primary, (b) Secondary, and (c) Tertiary
- Form locator 55: Estimated amount due (a) Primary, (b) Secondary, and (c) Tertiary
- Form locator 56: Billing provider national provider identifier (NPI)
- Form locator 57: Other provider ID (a) Primary, (b) Secondary, and (c) Tertiary
- Form locator 58: Insured’s name (a) Primary, (b) Secondary, and (c) Tertiary
- Form locator 59: Patient’s relationship (a) Primary, (b) Secondary, and (c) Tertiary
- Form locator 60: Insured’s unique ID (a) Primary, (b) Secondary, and (c) Tertiary
- Form locator 61: Insurance group name (a) Primary, (b) Secondary, and (c) Tertiary
- Form locator 62: Insurance group number (a) Primary, (b) Secondary, and (c) Tertiary
- Form locator 63: Treatment authorization code (a) Primary, (b) Secondary, and (c) Tertiary
- Form locator 64: Document control number also referred to as Internal control number (a) Primary, (b) Secondary, and (c) Tertiary
- Form locator 65: Insured’s employer name (a) Primary, (b) Secondary, and (c) Tertiary
- Form locator 66: Diagnosis codes (ICD)
- Form locator 67: Principle diagnosis code, other diagnosis and present on admission (POA) indicators
- Form locator 68: Not in use
- Form locator 69: Admitting diagnosis codes
- Form locator 70: Patient reason for visit codes
- Form locator 71: Prospective payment system (PPS) code
- Form locator 72: External cause of injury code and POA indicator
- Form locator 73: Not in use
- Form locator 74: Other procedure code and date
- Form locator 75: Not in use
- Form locator 76: Attending provider NPI, ID, qualifiers, and last and first name
- Form locator 77: Operating physician NPI, ID, qualifiers, and last and first name
- Form locator 78: Other provider NPI, ID, qualifiers, and last and first name
- Form locator 79: Other provider NPI, ID, qualifiers, and last and first name
- Form locator 80: Remarks
- Form locator 81: Taxonomy code and qualifier
Medicare Timely Filing Guidelines
On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act (PPACA), which amended the time period for filing Medicare fee-for-service (FFS) claims as one of many provisions aimed at curbing fraud, waste, and abuse in the Medicare program. Under the new law, claims for services furnished on or after January 1, 2010, must be filed within one calendar year (12 months) after the date of service.
The Affordable Care Act
The Affordable Care Act (Section 6404) reduced the maximum period for submission of all Medicare Fee-For-Service claims to no more than 12 months (one calendar year) after the date services were furnished. CR 7270 instructs that claims for services furnished:
Prior to January 1, 2010, must be submitted no later than December 31, 2010.
On or after January 1, 2010, the time limit for filing all Medicare Fee-For-Service claims (Part A and Part B claims) is 12 months, or one calendar year from the date services were furnished.
Exceptions Allowing Extension of Time Limit
Medicare will allow for the following exceptions to the one calendar year time limit for filing Fee-For-Service claims:
- Administrative Error:
This is where the failure to meet the filing deadline was caused by error or misrepresentation of an employee, the Medicare contractor, or agent of the Department that was performing Medicare functions and acting within the scope of its authority.
- Retroactive Medicare Entitlement:
This is where a beneficiary receives notification of Medicare entitlement retroactive to or before the date the service was furnished. For example, at the time services were furnished the beneficiary was not entitled to Medicare.
- Retroactive Medicare Entitlement Involving State Medicaid Agencies: This is where a State Medicaid Agency recoups payment from a provider or supplier six months or more after the date the service was furnished to a dually eligible beneficiary.
- Retroactive Disenrollment from a Medicare Advantage (MA) Plan or Program of All-inclusive Care of the Elderly (PACE) Provider Organization:
- This is where a beneficiary was enrolled in an MA plan or PACE provider organization, but later was disenrolled from the MA plan or PACE provider organization retroactive to or before the date the service was furnished, and the MA plan or PACE provider organization recoups its payment from a provider or supplier six months or more after the date the service was furnished.
Keeping Track of Timely Filing
- make sure that your claims are being sent correctly to the right insurance company the first time. This includes having a method in place of verifying the patient’s insurance coverage each time they come in to your office.
- when you send claims, generate the report from your software that lists all the claims that were submitted that day. This report comes in handy if your claim is incorrectly denied for timely filing.
- check your clearinghouse for rejected claims very regularly to make sure that all the claims you sent were actually sent to the insurance companies, and to correct any errors on your claims.
- Review your accounts receivable (A/R) reports. Keeping track of your claims is only one of the many jobs of the medical biller, but it is one of the most important.
- The biller’s primary role is to make sure that claims are paid and paid in a timely manner.