UB04 Medical Claim Form Billing

We recently received this email.

My daughter recently underwent detox in a clinical setting. The insurance company, United Behavorial Health is demanding that the claim be submitted on a UB92. The clinic is unfamiliar with these forms and only uses the 1500. They billed the services as H0008 and H0009 - All inclusive room and board plus ancillary. I found the Revenue Code of 0100 to be the 'companion' to those.

The clinic claims that only hospitals can use the UB92. How can I help them to understand that I cannot recover my $15,000 unless they use this form? Also, is this form extremely difficult to fill out. I'm sure this will be their next issue. They already have their money and now I would like to recover mine.

We gave this lady some suggestions for recovering her money, but we have received many questions lately regarding the use of the UB92 or actually the replacement UB04 form. The UB92 forms are obsolete and have been replaced with the UB04 form which allows for the NPI numbers.

It seems we have been receiving many questions on the use of the UB04 forms. Many clinics are billing only on CMS 1500 forms and getting their claims denied. Because of all these questions, we have added a new page to our website on Clinic Billing and we've published our latest ebook "UB04 Forms - How To Complete A UB04 Form Completely and Correctly - Line By Line, Box By Box"

Merry Christmas

We would like to express our best wishes for a happy holiday season to all who visit our blog.
Alice & Michele

Question About Locum Tenen

We recently were asked the question "How do you complete the HCFA 1500 form when using a Locum Tenen?" on our Ask the Biller page.

Michele's answer was "You should be using the locum tenen’s individual NPI & legacy numbers in box 24 J, and their name in box 31. Then the group name address and GROUP npi in box 32 & 33."

There still seem to be many questions of the use of NPI numbers. For more free information on the use of NPI numbers, visit our NPI page.

Electronic Reports Notebook

If you are sending your medical insurance claims electronically, be sure to read Michele's Blog post on keeping track of these batches of electronic claims in a notebook. You can read about her suggestions at Michele's Blog.

UB04 Instructions Now Available

Michele and I have been working hard to make the December 1 deadline for our new book "UB04 Forms - How To Complete A UB04 Form Completely and Correctly, Line By Line, Box By Box." Hooray!! It's finished.

This book is now available for a discounted price of $29. until Monday December 3, 2007.

Billing C-Leg repairs

We received a question from Marilynne this week asking about billing for C-Leg repairs. We haven't had any experience with this yet and Michele wasn't able to locate any information on it so we're asking for help for Marilynne. Here's her question -

I have a question in regards to C-Leg repairs …..payment from Medicare…..how are other DME providers submitting there claims and getting paid….I hope you have some insite on this matter. Happy Thanksgiving..Thank you Marilynne

If you can help, please respond to this post and we'll let Marilynne know.


Thanks,
Alice

January 23, 2008
Be sure to check out the comment on C-Leg repairs - Thanks Jane

CAQH Credentialing

Are you familiar with CAQH and the CAQH credentialing process? Many of us are hearing more and more about it lately. Insurance companies are asking if you are credentialed through CAQH. What is it and why would you use it?

CAQH is a non profit organization which has come up with a universal credentialing system for providers of medical services. Once you complete a CAQH application, insurance companies can access that information online.

The largest benefit of this is that it will reduce the number of applications you must complete to become participating with insurance companies. The CAQH application is quite involved to complete, but well worth the problems. Here's more information about CAQH on our website.

UB04 Billing for facilities

We got an email from someone today that shows there is a lot of questions yet on billing for clinics. The lady was trying to get reimbursed for services she paid for on her daughter for drug rehabilitation. The claims were denied because they were not filed on UB04 forms. The facility told her that they bill only on CMS 1500 forms.

If the clinic is credentialed as a facility then the billing must be done on the UB04 forms. I think because they are unfamiliar to most offices, the clinics just do not want to have to learn to use them. But unfortunately, they are loosing money by not filing on the correct forms. They are a little more complicated than the CMS forms, but unfortunately they are necessary for payment.

We've just added a page to our website on facility billing. If you have any more questions on billing on UB04 forms, visit our facility billing page.

UB04 instructions available Dec 1

We are now completing our book "How to Complete a UB04 Form Correctly and Completely - Line By Line, Box By Box". It will be available as an e-book in PDF format for immediate download December 1, 2007. The cost of this book will be $39.95, but we are offering a special discount price to our readers of $29.00 if you place your order before the December release. Just place your order now. We will send you an email when it is available for download. You'll pay for it when you download it.

This book will be available in soft cover also from Amazon.com. Due to the technical issues of publishing, it should be available by the middle of December.

Also, three of our other books are now available through Amazon.com in soft cover. They are:

"How To Start Your Own Successful Medical Billing Business"
"12 Marketing Strategies to Grow Your Medical Billing Business"
"How To Complete a CMS 1500 Completely and Correctly - Line By Line, Box By Box"

These three books are also available as ebooks in pdf format for immediate download from our website.

Billing Codes Separately

We recently had someone ask us on our "Ask the Biller" page about billing for a Nebulizer treatment. The question was when you bill for a Nebulizer treatment do the drugs get bundled in or should you bill separately for them. If you would like to read Michele's answer to the question, click on the "Ask the Biller" link and look for the October 16 entry. Michele also has an interesting article on bundling at her blog.

My point is that a million questions come up like this in every billing office. If you haven't had a lot of experience with medical billing, this can be a problem. It can be difficult to know the correct answer or where to look for it.

That is the point of this blog and our Ask the Biller page. We truly enjoy helping others who have medical billing questions. So if you've got one, ask away. We'll do our best to get an answer for you.

Setting Up A Mailroom

When you submit medical insurance claims to insurance carriers, even if you are sending them electronically, you will still have lots of claims to mail. Many claims are still not accepted electronically and many companies don't have the capability of accepting secondary claims electronically.

We quickly found that we had to work out a system for getting these claims in the mail efficiently. We developed a great system for sorting, stuffing and mailing these claims.

We start with two corrugated boxes we found at an office supply store divided into 30 sections each. They are also available in wood and steel and are called literature organizers. I labeled about ten of them with the most common insurance companies we deal with. I then started with A and went to Z using either one or two letters per compartment. As insurance claims are printed and ready to mail, they are sorted into the correct compartment for that particular insurance company. Excellus has it's own slot for all the insurance claims we submit to the local Excellus. We get a few claims that must be sent to Excellus in Florida or Mississippi, etc. Those out of state claims are placed in the E slot.

The claims are now presorted. When we are ready to mail them, we take the A's first and look through them to make sure no Aetnas or American Progressive (which have slots of their own) were placed in this bin in error. The A's are sorted, folded, and placed in window envelopes with our return address imprinted. We can place up to 14 forms in a business size envelope without going over the weight restriction for this size. I fold one form for the front window and then fold the others together behind the front one. If you fold them all together, it pushes the address lower in the window and sometimes doesn't fit the window properly. These must be folded as tight as possible as there is a thickness allowance for this size envelope.

When we have over 14 claims to one address, they are not folded and go into a large window envelope made for HCFA's. The postage rate for this size envelope is higher than for a small envelope so we use the small ones when possible.

When all claims are in their envelopes, we weigh them and add the proper postage. I do not use a postage meter machine as it is an added expense and not necessary. We are a small office that does not have a problem with stamps disappearing so we purchase a variety of stamps. I have a chart that I update with each postage increase to indicate exactly which stamps to apply to each envelope weight.

If you mail a lot of claims the post office has free information they will give you regarding the limitations on the size of the envelopes you can use and a slotted cardboard your smaller envelopes must fit through. It's much better to know all their new rules and avoid getting your mail returned and claims delayed.

Billing Medical Claims Electronically

We have finally reached the stage where most offices are billing at least some of their medical claims electronically. But the more important question is, are they reading their electronic reports?

Just sending the claims in electronically is not enough. If you are not reading the electronic reports, then you are losing money. It is crucial to your practice that these reports are being read and being read regularly. If you say you don't have time to be checking the reports, then I say that you don't have time NOT to check the reports.

The first report that comes back when you submit the claims electronically lets you know if the batch made it to the clearing house. This is pretty important because you don't want to loose a whole batch of claims that will affect your cash flow. Interruptions in the phone lines or lots of other things can cause a whole batch to get kicked out.

Another report will tell you if the insurance company is accepting the batch. This report will let you know if any individual claims have errors causing them to not be submitted. An example of this is when a claim is dropped for an incorrect ID# or no longer a member with that insurance carrier.

Their are many advantages to billing electronically at this stage. If you are a provider who is seeing the patient regularly, such as a chiropractor or a psychologist, you find out much sooner than you would by filing on paper that a patient's coverage has changed. You can ask the patient on the next visit if the insurance information has changed - before you've billed them for six visits and they all were denied.

If you are a billing service and must keep track of many providers electronic reports, it is crucial to keep an electronics log. Next month we'll explain how we set up our electronics logs for 50 providers.

Copyright 2007- Alice Scott

Sunday Afternoon

Hi again,
What a week. Sometimes we end up on the medical end instead of the medical billing end. Being a very healthy person who goes to the doctor very seldom, I really dislike medical emergencies. I took a long weekend off last weekend and visited my sister in Florida. It was a good trip but when I got home Tuesday night and called my 90 year old mom, she didn't sound right. To make a long story short, what looked like she had suffered her first stroke turned out to be dehydration from a viral infection. After a brief stay in the hospital, she's back taking care of her house and cat again.

So I'll get right back to my medical billing jobs again. Sorry for a couple "Ask the Biller" questions I didn't get to answer right away. I'll get to work on the newsletter again, too. Should be getting the newsletter out later this week. I'll be writing about billing claims electronically, setting up a mailroom, news on our books, and more. If you would like to sign up for our free monthly newsletter, you can sign up by on our website.

Thanks for reading.
Alice

Sunday Morning

It's early Sunday morning and I'm just sitting here at my computer thinking about how much things have changed. Our office manager had gall bladder surgery Friday - and she expects to be back to work tomorrow morning. A surgery that once had a several week recovery time has come so far that Shelly will be back on Monday.

In many ways the insurance billing for the surgery has also come a long ways. A few years ago employees sat at typewriters and typed in claims information. It took several minutes to complete a form which was then mailed to the insurance company. The claim was then passed through many hands from the people in the mail room who opened the envelope to the final processor who makes the decision on whether or not the claim is paid. This was a several week process.

Now most of our claims are sent electronically through the computer. Insurance companies love this. It cuts way down on the amount of time employees are handling the claims which cuts down substantially on their costs. Physicians love this. Their payments come much quicker. Problem claims are found much sooner and dealt with before they are denied. This brings their outstanding receivables (or cash) in much quicker.

Now we even have electronic remittances which will post payments automatically to your practice management system. What will we see next?

Are you billing your insurance claims electronically? For more information on electronic claims submissions visit our page on electronic billing.

Qualifiers for Medisoft

A big thanks to Jan R from Internal Medicine Specialists for her email on qualifiers for Medisoft. We recently had someone ask for a list which we were unable to locate. Here it is.


In reference to the question someone asked about qualifiers (for the Medisoft software) - You can go into the Medisoft website and do a search for qualifiers or I have listed below what the qualifiers are. Hope this helps!
0B - State License Number
1A - Blue Cross Provider Number
1B - Blue Shield Provider Number
1C - Medicare Provider Number
1D - Medicaid Provider Number
1G - Provider UPIN Number
1H - Campus Identification Number
1J - Facility ID Number
B3 - Preferred Provider Organization Number BQ - Health Maintenance Organization Code Number EI - Employer's Identification Number FH - Clinic Number
G2 - Provider Commercial Number
G5 - Provider Site Number
LU - Location Number
SY - Social Security Number
U3 - Unique Supplier Identification Number
X5 - State Industrial Accident Provider Number
This information is typed into the PINS field (under Insurance).

Jan R.

Thanks Jan - we appreciate your help.
Alice

Listing our ebooks on Amazon

Today we received our ISBN #s so that we can now apply to sell our books thru Amazon.com. It's very exciting for us as in the past we've only offered them for sale on our own website and thru Ebay. We now offer the following books in ebook format.

"How To Complete a CMS 1500 Completely and Correctly - Line By Line, Box By Box".

"How to Start Your Own Successful Medical Billing Business"

"12 Marketing Strategies to Grow Your Medical Billing Business"

We are currently working on "How To Complete a UB04 Completely and Correctly" and hope to have it for sale in November.

Let us know your needs and we'll see if we can work them in.

Alice :)

NPI # in Wrong Box Causes Claim Denials

We recently signed up two new doctors for our billing service. The reason they decided to use a service was because their Medicare claims were all being denied. These two doctors are not located in New York so we contacted the Medicare office in their area. It took several calls and we went through many automated systems before finally getting to the bottom of the problem.

We thought perhaps the denials were caused because the Medicare PTAN was not entered on the claim. Maybe they were not yet able to accept claims without both the NPI # and the Medicare PTAN. But these claims denied because the providers put their NPI # in box 17B.

This is just another example of how important it is to understand NPI #s. Many offices still do not know they need a Type II NPI #. If you are receiving any claim denials for NPI #s be sure to download our free copy of "NPI Numbers - Everything You Need To Know About NPI Numbers" .

If you are having a problem with claim denials, you need to read our ebook "How To Complete a CMS 1500 (HCFA 1500) Completely and Correctly - Line By Line, Box By Box" . Avoid costly mistakes. Make sure your claims are filed correctly the first submission.

Purchasing Medical Billing Software

We've had several occasions to look up medical billing software on the internet and always have been frustrated by the sites that sell the software. They ask you all these questions about your practice and how much you want to spend but it's difficult to just compare the different software programs available and find the prices.

Many people ask us on our "Ask the Biller" page about purchasing software. We know about Lytec extensively because we use Lytec every day. We also know about several others, such as Medisoft, Eclipse and Perfect Care as we've had occasion to use them in some of our provider's offices. Some are designed for small practices and some are designed for large groups or hospital billing.

We've decided to put up a page on our website comparing the different medical billing software available. We want to give you an idea of what each of the software packages offers, what type of office they work best for, and how much they cost, etc. We want to use screen shots of each software so you can see what the program looks like before you purchase it and what the cost of each software package is.

Nellie needs help with Medisoft qualifiers

I recently got this question on our Ask the Biller page.

Do you have a list of the qualifiers that are needed for each area in medisoft (eg. what is the qualifier code when you enter a procedure that is not on your system and the bottom box says code ID qualifier.)? Also the ref dr's need a qualifier and ins co's? Do you have a list of these?

Please share with me...

sincerely,

Nellie

Michele answered

Hi Nellie,
Thanks for your question. I use Lytec, which is similar to Medisoft, but Lytec does not have the qualifier fields like Medisoft does. I tried to find a list of the qualifiers used in Medisoft but I wasn’t able to. The only qualifiers I know of are the ones to identify the type of insurance carrier in electronic claims submission which is not what you are looking for. I will post your question and maybe another Medisoft user could email us if they have lists of qualifiers.


So if anyone can help Nellie, we would appreciate it.

Thanks,
Alice

Newsletter published today

Hi,

Well, we sent out our free monthly newsletter today. If you are not yet a subscriber, be sure to sign up for your free copy at Solutions Medical Billing.

This month's newsletter covered

• starting a new private medical practice
• NPI registry website down
• Bundling CPT Codes
• New look to our website
• medical billing and coding schools
• projects we are currently working on

If you have any suggestions for articles, let us know. We're here to answer your questions.

See you later.

Alice

HCFA Envelopes too large

I'm having a bit of a problem with my large HCFA envelopes. According to the new rate increases at the post office my large HCFA envelopes that hold multiple claims unfolded with the address of the insurance carrier showing through the window are one inch too long to be considered a large envelope. They want me to pay a package rate which is quite a bit more than the large envelope rate. Now if the envelope were addressed sideways instead, it would be alright but the height can only be 12" and these envelopes are 13" tall.

I found a solution to the envelopes I have in stock. I fold over the bottom edge and tape it with packing tape to make the envelope only 12" high. The HCFA form we place in the window must then be folded about an inch from the bottom so the address shows through the window.

The problem is that I need to reorder. I hate to have to do this to the next 500 envelopes when thousands of others must be having this same problem and the solution would be in making the envelopes 1" shorter. If anyone out there has any connections with the people who manufacture these envelopes, please convey my wishes.

We use many of these envelopes every week. I don't want to go back to having to print labels for each insurance and putting them in plain envelopes. Has anyone else run into this problem. I'm eager to hear.

Alice

What is Solutions Medical Billing

Every once in awhile someone sends us an email thanking us for an answer we have provided on the "Ask the Biller" page or for writing our newsletter. I got one today saying thanks for all the information that we share in our newsletter and that it is very helpful to them.

Maybe this sounds a little corny, but we feel good when we help someone. It doesn't take a lot of time to answer a question and sometimes it saves the reader a big headache. When we started our business in 1994, we didn't have anyone willing to help us get answers to our questions. And we had a lot to learn. It wasn't long before others started asking us questions. Mostly they asked us about starting their own medical billing business. Remembering how difficult it was for us to find answers, we vowed to help others so we took the time to answer their questions.

In fact, so many people called us about starting their own medical billing business that we wrote our first book about it - "How to Start Your Own Successful Medical Billing Business" in 1999. We found that people who wanted to start their own business had lots of questions and we could be on the phone for an hour answering them all. There was too much to tell them at one sitting. We've sold hundreds of copies of that book and gotten wonderful response from our readers. We found that we enjoy helping others.


Solutions Medical Billing is a small business, run by myself and my daughter. There are nine of us (all friends) who work on about 50 accounts of a variety of providers. Many of our doctors are within a 20 mile radius and we pick up their information weekly but many of our doctors we've never even met. We've developed a great support team of people we can call on when challenges do arise or when one of our readers asks us a question that we cannot answer.

Don't get me wrong, we're not naive. We have been burned by a few others we thought were trying to help us. We had the choice of being mad at them and never reaching out again or remembering who you cannot trust and go on helping when we can. We just like helping people.

So keep sending your questions to us on our ask the biller page. We'll keep answering them to the best of our ability. If you have any suggestions for our newsletter articles, send them along too. We truly enjoy helping others.

Alice

Welcome

Hi, welcome to my blog. My daughter/partner Michele and I offer a website on medical insurance billing. We offer help to those in the medical insurance billing field who have questions on our Ask The Biller page. We've decided to take some of the questions that seem to be asked about the most often and write about them on our new blog.

We also publish a monthly newsletter free of charge to anyone interested in reading it. You can sign up to receive your free subscription here. We write about news in our field and offer helpful hints on many subjects from getting your claims paid correctly and quickly to small things that will help the office run more smoothly.

We also offer a few ebooks on the subject of medical insurance billing. You can read about them on our website. Thanks for visiting.

Alice Scott