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Changes allow distributors to treat old forms like new products
By Andy Brown
The two primary forms used by health care businesses to bill for services have been redesigned. The National Uniform Billing Committee, which is responsible for standardizing the billing forms used in health care claims, mandates that the new forms—CMS 1500 and UB-04—be implemented by April 1 and May 23, respectively.
Health care companies should be updating their software and testing the new forms by now, but many aren’t. They face potential revenue loss if the deadlines pass and they aren’t using the new forms, because claim centers and clearinghouses will stop accepting the old versions without exception. Knowledgeable distributors who assist current customers and prospects with the transition can strengthen relationships and add value to their offerings.
Background on the Forms
Forms CMS 1500 and UB-04 replace versions that are nearly 15 years old. Both forms were originally used
by health care companies to bill for services covered by Medicare program. However, the entire medical community has adopted the forms. For billing purposes, the forms distinguish between institutional providers and non-institutional suppliers of health care services. Institutional providers, such as hospitals, health clinics and hospice care, are required to use form UB-04. Non-institutional businesses, such as physicians’ private practices, medical groups and laboratories, use CMS 1500.
Two emerging factors prompted the forms’ changes. The first is the use of electronic forms to file medical claims. The health care industry continues to adopt this method of billing, but significant discrepancies existed between the electronic and paper forms, including the absence of some billing codes on the electronic forms. Those differences have largely been eliminated in the revised forms.
New Forms at a Glance
UB-04
March 1: Health plans, clearinghouses and other information support vendors must be ready to accept the new UB-04 Billing Form.
March 1 through May 23: Providers can use either the current UB-92 or the new UB-04 Billing Form.
May 23: The UB-92 is discontinued; only the new UB-04 billing form is to be used. All rebilling of claims should use the UB-04 billing form from this date forward, even though earlier submissions may have been on the UB-92.
CMS 1500
October 1, 2006 through March 31, 2007: Providers can use either the current (12/90) version or the revised (08/05) version of the CMS-1500 Claim Form.
April 1: The current (12/90) version of the CMS-1500 Claim Form is discontinued; only the revised (08/05) form is to be used. All rebilling of claims should use the revised (08/05) form from this date forward, even though earlier submissions may have been on the current (12/90) 1500 Claim Form.
The creation of a National Provider Identification (NPI) system also necessitated changes in the forms. The Federal government requires health care entities to replace whatever identifier number they currently use with an NPI by May 23. The revised CMS 1500 and UB-04 forms are both designed to accommodate users’ NPI numbers.
How the Changes Help Distributors
Periodic changes to the billing forms are inevitable. Distributors can take advantage of the changes to grow their businesses. “A new form is like having a new product,” says Jim Magadelno, compliance manager, sales and marketing, at TFP Data Systems, Oxnard, Calif. “There’s information that needs to be disseminated to customers. The medical industry does what it can to filter out the information, but it doesn’t always get to the right person.” That’s where an informed sales rep steps in.
“The distributor should convey to doctors or office managers that they need to test the system that they’re switching to,” Magdaleno says. “It’s a billing form. It generates revenue, so they need to make sure it works properly in their system.” He suggests that distributors make sure their customers have enough of the current forms on hand to last through the transition and that they have enough of the new forms in time for the deadlines.
According to Walter Loughney, president of RX Data Systems, Lake Park, Fla., there is still plenty of opportunity for distributors: “Doctors aren’t the swiftest people in terms of forms,” he says. “Half of them know there’s a new form, but don’t realize that they have to change their software.”
Loughney recommends establishing a relationship with doctors’ offices by explaining the changes and offering the forms at competitive prices—perhaps even as loss leaders. Once your foot is in the door, the chances to pick up more business increase. “The health care industry as a whole, despite the move to electronic records, is still a major consumer of printed products,” he says. Magdaleno seconds that notion: “Even people billing electronically still file a paper copy.”
Providers by Category
Individual physicians, non-physician practitioners and other health care suppliers are considered non-institutional. They must start using the CMS 1500 form by April 1:
• Physicians (all specialties) |
• Ambulatory surgical center |
The following business types are considered institutional. If you work with these clients, they must start using the UB-04 form by May 23rd:
• Community mental health center |
• Indian health services facility |
For more information about health care billing forms, visit these web sites:
Centers for Medicare & Medicaid Services
www.cms.hhs.gov
National Uniform Billing Committee
www.nubc.org
Photos courtesy of TFP Data Systems, Oxnard, Calif.