Individual practitioners should use HCFA-1500. Medical facilities should use UB-92, which is now referred to as UB-04. Let’s define individual practitioners as non-institutional health care providers or medical professionals, such as individual doctors, nurses, and therapists. They would use the HCFA-1500 form.

What does UB 92 stand for?

HCFA 1450, Uniform/Universal Billing form 92 Managed care The official HCFA/CMS form used by hospitals and health care centers when submitting bills to Medicare and 3^rd-party payors for reimbursement for health services provided to Pts covered. See Compliance.

What is a HCFA 1500 form used for?

CMS-1500 Form (sometimes called HCFA 1500): This is the standard health insurance claim form used for submitting physician and professional claims to bill Medicare providers. In other words, the CMS-1500 is used for individual provider claims and is used to submit charges under Medicare Part-B.

What is a UB 92 claim?

Form UB 92 is also known as a Uniform or Universal Billing form. It is used in the healthcare industry to submit insurance claims to Medicare or other health insurance companies. Completion of this form helps insurance companies decide whether the healthcare provider should receive reimbursement.

What is the difference between a UB and HCFA?

The UB-04 (CMS 1450) is a claim form used by hospitals, nursing facilities, in-patient, and other facility providers. On the other hand, the HCFA -1500 (CMS 1500) is a medical claim form employed by individual doctors & practices, nurses, and professionals, including therapists, chiropractors, and out-patient clinics.

What does UB in UB-04 stand for?

Definition. UB-04. Uniform Billing Form (claims)

What is cms1500?

The CMS-1500 form is the standard claim form used by a non-institutional provider or supplier to bill Medicare carriers and durable medical equipment regional carriers (DMERCs) when a provider qualifies for a waiver from the Administrative Simplification Compliance Act (ASCA) requirement for electronic submission of

What is a HCFA in medical billing?

HCFA: The Health Care Finance Administration, the part of the U.S. Department of Health and Human Services (HHS) that is responsible for administering Medicare and Medicaid. See: Medicare. Also see: Medicaid.

Who will use CMS 1500 claim form for billing the medical services?

The non-institutional providers and suppliers who can use the CMS-1500 form to bill medical claims include Ambulance services, Clinical social workers, Physicians and their assistants, Nurses including clinical nurse specialists and practitioners, Psychologists, etc. The form is usually not hospital-focused.

What is the difference between HCFA 1500 and CMS 1500?

The HCFA 1500 claim form, also known as CMS-1500, enables medical physicians to submit health insurance claims for reimbursement from various government insurance plans including Medicare, Medicaid and Tricare. The HCFA-1500 form (CMS-1500) is used to submit charges covered under Medicare Part B.

Is a UB 92 the same as a UB-04?

A number of things were added to the UB92 form when it underwent the revision to become UB04. The main change is the addition of the field in which to input a National Provider Identifier (NPI). Additional fields were also added like more diagnosis code fields.

What is a HCFA 1450?

The Form CMS-1450, also known as the UB-04, is the standard claim form to bill Medicare Administrative Contractors (MACs) when a paper claim is allowed. In addition to billing Medicare, the 837I and Form CMS-1450 sometimes may be suitable for billing various government and some private insurers.

What Bill type is used for inpatient billing?

Bill Type 111 represents a Hospital Inpatient Claim indicating that the claim period covers admit through the patients discharge.

What is a UB claim form used for?

An itemized medical bill lists in detail all the services that were provided during a visit or stay—such as a blood test or physical therapy—and may be sent to the patient directly. The UB-O4 form is used by institutions to bill Medicare or Medicaid and other insurance companies.

What are the two types of claim form?

As previously mentioned, there are two types of claims in health insurance, Cashless and Reimbursement Claims.

What is difference between professional and institutional claims?

Institutional billing also sometimes encompasses collections, while Professional claims and billing typically doesn’t. Professional billing controls the billing of claims generated for work performed by physicians, suppliers, and other non-institutional providers for both outpatient and inpatient services.