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Dawn Moreno
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Frequently, I am asked by students which form to use between the CMS-1500 form versus the UB-04 form. In most medical billing training programs, it is taught that inpatient billing uses the UB-04 form and outpatient billing uses the CMS-1500 form. Ambulatory surgical centers are outpatient but are sort of hospital-like in nature, so this causes confusion.
Medical Billing Education – Form Use for Ambulatory Surgical Center Billing
In answering this question comprehensively, let’s talk about the main difference between the two forms. The UB-04 form is used for inpatient billing because there is more space on it and places to add in the numerous supplies used during a hospital stay. Can you think of a time when you were in the hospital, and every time the nurse would bring a Q-tip, cotton swab, bed pan, etc. they would scan it onto your chart? I’m sure in looking at past hospital bills you wonder how a Band-Aid could cost $10. That $10 covers the supply such as a Band-Aid and the time it took a qualified nurse to get it, bring it to you, and to scan it onto your chart.
Conversely, when you go to the doctor for a sore throat or other encounter, few supplies are used. Basically, billing entails a diagnosis or diagnoses, a procedure, and it’s done. So, the CMS-1500 form reflects the lesser complexity of this type of visit.
So, back to our original question, what form should ASCs use? The answer is both!
An ASC that is attached to a hospital will most likely bill out on the UB-04 form. An ASC that is a free-standing facility will most likely use the CMS-1500 form. ASCs are usually used for less complex procedures so the CMS-1500 form can suffice. However, hospitals like to standardize everything, and so when an ASC is connected to a hospital it is likely they will use the UB-04 form instead.
By: Dawn Moreno, PhD, CBCS, CMAA, MTC. Lives in the beautiful Southwest United States and has been an instructor for medical coding/billing for the past 7 years. Interested in quality medical billing training? Click Here for Medical Billing Education Courses
Learn More Details about Medical Billing Education
Medical Billing and Coding Training – General Surgery Guidelines – Part 1
AAPC – Certified ASC Coder (CASCC™) Credential
The post Medical Billing Education – Form Use for Ambulatory Surgical Center Billing appeared first on [CCO] Medical Coding.
Continue reading...
Frequently, I am asked by students which form to use between the CMS-1500 form versus the UB-04 form. In most medical billing training programs, it is taught that inpatient billing uses the UB-04 form and outpatient billing uses the CMS-1500 form. Ambulatory surgical centers are outpatient but are sort of hospital-like in nature, so this causes confusion.
Medical Billing Education – Form Use for Ambulatory Surgical Center Billing
In answering this question comprehensively, let’s talk about the main difference between the two forms. The UB-04 form is used for inpatient billing because there is more space on it and places to add in the numerous supplies used during a hospital stay. Can you think of a time when you were in the hospital, and every time the nurse would bring a Q-tip, cotton swab, bed pan, etc. they would scan it onto your chart? I’m sure in looking at past hospital bills you wonder how a Band-Aid could cost $10. That $10 covers the supply such as a Band-Aid and the time it took a qualified nurse to get it, bring it to you, and to scan it onto your chart.
So, back to our original question, what form should ASCs use? The answer is both!
By: Dawn Moreno, PhD, CBCS, CMAA, MTC. Lives in the beautiful Southwest United States and has been an instructor for medical coding/billing for the past 7 years. Interested in quality medical billing training? Click Here for Medical Billing Education Courses
Learn More Details about Medical Billing Education
Medical Billing and Coding Training – General Surgery Guidelines – Part 1AAPC – Certified ASC Coder (CASCC™) Credential
The post Medical Billing Education – Form Use for Ambulatory Surgical Center Billing appeared first on [CCO] Medical Coding.
Continue reading...