Unit 1 Assignment

HS225-01 Unit 1 Assignment
Amy Burton
Kaplan University
January 12, 2014

What kind of healthcare institutions uses the two forms? Be specific and provide examples.
Healthcare institutions and providers are required to submit a paper billing document for services provided to patients. There are two forms used, the CMS-1500 is the standard form use by physicians and suppliers, the CMS-1450, also known as UB-04, used the standard form used by hospitals for both outpatient and inpatient services, third-party payers for services provided by hospitals for outpatient and inpatient care, and ambulatory surgery centers (ASCs) (Smith 2013). * How do the two forms differ?
The two forms are similar in the information required for completion. The differences between the two forms are the location of services provided (ex. Hospital, physician’s office) and what committee is responsible for creating and updating the forms. The National Uniform Claim Committee is responsible for the yearly updates of the 1500 (NUCC, 2012); the National Uniform Billing Committee is responsible for the UB-04 (NUBC, 2013). The 1500 is used for services provided by a physician or supplier usually in an office setting, and the UB-04 is used for services provided in a hospital, inpatient or outpatient, or ambulatory surgery centers. * What types of patient information, codes, and insurance information are entered on each of the billing forms?
The 1500 and UB-04 require the same types of information: Patient, payer, 2nd payer, addresses; member (patient) and providers ID numbers, type of plan the patient is covered under (ex. Medicare, group health plan), name of patient and DOB of patient receiving services or supplies, provider and payer taxonomy code and area of specialization, diagnosis codes, authorization and place of service codes, date of service, and service providers