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As a long-term care professional, you are well aware of the importance of accurate billing and claims management. This process involves the timely submission of claims to insurance companies and government programs, such as Medicare and Medicaid, through the UB-04 form. 

The complexity of billing and claims submission in long-term care can be overwhelming, as in understanding the different forms and codes required. In previous blogs, we have looked at the SNF billing, the Medicare 8-minute rule, and how PDPM works.

Therefore, in this blog, we will focus specifically on the UB-04 form so you and your facility staff members can find all the information in one convenient place. 

What Is a UB-04 Form?

So, what is a UB-04 form? A UB-04 form—formerly known as the CMS-1450 form—is a standard claim form used by long-term care facilities to bill for all services provided to residents. This form is must be submitted to Medicare, Medicaid, and other third-party payors in order to process a claim. 

The UB-04 form contains information on the facility, patient, services provided, and the charges for those services. The form also includes codes for different services and procedures, which are used by insurance companies to determine reimbursement rates.

You should note that the UB-04 form contains 81 fields or lines, referred to as form locators. To learn more about the form locators and lists, you can download the PDF document below, from the San Francisco Health Plan, which includes helpful instructions on how to complete them.

A nurse filling in a form, to be used for filling in the UB-04 form.
A UB-04 form—formerly known as the CMS-1450 form—is a standard claim form used by long-term care facilities to bill for all services provided to residents.

Those who are likely to use the UB-04 form for billing the following institutional facilities:

  • Hospitals
  • Skilled Nursing Facilities (SNFs)
  • Hospices
  • Rural health clinics
  • Specialized healthcare centers (ICFs, rehabilitation clinics)

To ensure facilities and their staff can complete the form correctly, the CMS has provided further reading: Chapter 25 of the Medicare Claims Processing Manual for coding guidelines. Doing so will ensure claims are processed accurately and promptly. However, the process can still be confusing, so in our next section, we have put together some helpful tips to successfully complete the UB-04 form. 

Tips for preparing a UB-04 form

When filling in a UB-04 form, keep these tips in mind to minimize any mistakes: 

A physician who understands what is a UB-04 form verifying patient insurance eligibility.
Different insurance providers require different data on the UB-04 form. One should verify with each insurance provider the data they need before submitting the form.
  1. Verify with each insurance provider what data they require: Different insurance providers require different data on the UB-04 form. Thus, verify with each insurance provider what data they need before submitting the form, so as to avoid any delays in payment due to missing or incorrect data.
  2. Check that all completed data in the UB-04 form is correct and in the right field: This includes the patient or resident’s name, insurance information, diagnosis and procedure codes, service facility location, and National Provider Identifier (NPI) information. Make sure to double-check all data for accuracy, as any errors may result in delayed payment.
  3. Add the patient or resident’s name and insurance information exactly as they appear on their insurance card: This is crucial, as any discrepancy in information may result in payment delays or denials.
  4. Use the correct diagnosis codes (​ICD-10), procedure codes (CPT/HCPCS), and revenue codes: These codes ensure that the services provided are appropriately coded for billing purposes.
  5. Use only the physical address for the service facility location field: This means any PO Box, mailing address, or other non-physical addresses cannot be used, as they can cause errors when processing claims.
  6. Add the National Provider Identifier (NPI) information where needed: An NPI is a unique identification number that healthcare providers use for billing and other purposes. This number should be added in the required section to ensure that claims are processed accurately and without delay.

In addition to the above, one should always remember that a long-term care EHR with exceptional financial capabilities can prove to be invaluable in claims submission using an 8371 electronic standard due to its automated data organization capabilities.

Contact us here if you would like to demo our long-term care financial software.

UB-04: Type of Bill 

Before we conclude on the topic of UB-04 forms, it’s worth looking at the UB-04, type of bill. This refers to the 4-digit code in the form locator 4 of your UB-04 form that should be populated according to the UB-04 form field descriptions and instructions provided in this PDF document from the San Francisco Health Plan

To answer the question of what is a UB-04 form type of bill, it is a 4-digit code used to identify the type of facility, type of care, and frequency code. The full UB-04 codes list is available on the NUBC website.

The Importance of Avoiding Errors When Filling a UB-04 Form

Medical coding and billing errors when filling in a UB-04 form can have severe consequences for healthcare providers, particularly for practices with a history of incorrect coding and billing mistakes. These practices may face intense scrutiny for medical billing fraud and abuse, which can lead to serious federal penalties and fines.

A nurse who understands the UB-04 type of bill having a discussion with a patient.
The most common consequence of medical coding and billing errors is having the claims denied by insurance companies.

Medical billing fraud can occur when practices falsify claims for their monetary gain, whether intentionally or unintentionally. Falsifying claims is a direct violation of the Federal Civil False Claims Act. Civil penalties for violating the act may include recovery of up to three times the amount of damages sustained by the government as a result of false claims, as well as penalties per false claim filed.

Also, defrauding any government healthcare benefit program can result in imprisonment. Thus, one should always note that mistakes can be costly, as the law does not require intent for a violation. 

The most common consequence of medical coding and billing errors would be having the claims denied by insurance companies. This can lead to a significant loss of revenue for long-term care providers.

To minimize these errors, it’s crucial for an MDS nurse to double-check all claims for accuracy and compliance with regulations and guidelines. This includes using the correct coding, employing the use of an effective long-term care EHR, and submitting the necessary documentation. 

Long-term care providers can also benefit from investing in proper EMR systems training and resources to stay up-to-date with coding and billing requirements, reducing the likelihood of errors and potential penalties.

For more on recent trends in long-term care, read our blog and subscribe to the LTC Heroes podcast.