Health Information Management

Tip of the Week: Make sure your payers are aware of the UB-04 changes

APCs Insider, June 8, 2007

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Many of the bumps in UB-04 implementation will not be the result of billing staff errors, says Claudia Birkenshaw, MSA, CEO of Modern Management Muse, LLC in Flint, MI. In particular, Birkenshaw says some payers may be caught by surprise by the new form, especially auto and workers compensation carriers.

For example, FL 29 (auto accident state) allows you to record the state in which an auto accident occurred; however, Birkenshaw says that some payers may not be aware that the field exists.

"We send medical records to prove where an accident occurred for a coordination of benefits issue, and if the insurer doesn't know they can look for it on the form, they will request additional records and withhold payment," she says.

This could result in delays of payment to your hospital. Birkenshaw recommends calling your payers to find out whether they are aware of the new form, and suggest they subscribe to the National Uniform Billing Committee (NUBC) to receive the NUBC's UB-04 Data Specification Manual (www.nubc.org/become.html).

(The above tip appeared in the July issue of Briefings on APCs).



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