1. Hospital Billing Overview Access Training and Development Department

2. What We Will Review UB04 and CMS 1500 UB04 and CMS 1500 Professional vs. Technical Services Professional vs. Technical Services Creating a UB04 Creating a UB04 Billing Edits Billing Edits Chargemaster Chargemaster Medical Coding Medical Coding How Registration Impacts Billing How Registration Impacts Billing

3. UB04 Uniform Bill 2004 Uniform Bill 2004 –Multitude of boxes –Customized by payers For Technical Services only For Technical Services only Produced on paper or electronically Produced on paper or electronically

4. CMS 1500 Centers for Medicare and Medicaid Services 1500 Centers for Medicare and Medicaid Services 1500 –Multitude of boxes For Professional Services only For Professional Services only Produced on paper or electronically Produced on paper or electronically

5. Professional Charges Services performed by physicians or physician extenders Services performed by physicians or physician extenders –Nurse Practitioners –Midwives –Physician Assistants Billed on the CMS 1500 Billed on the CMS 1500 No CMS 1500s produced by Scripps No CMS 1500s produced by Scripps

6. Technical Charges Services, supplies, and medications provided in a setting other than a physician’s office Services, supplies, and medications provided in a setting other than a physician’s office –Hospitals –Ambulatory Surgery Centers –Imaging Centers Billed on UB04 Billed on UB04 Only bill form produced by Scripps Only bill form produced by Scripps

7. Creating A UB04 Eclipsys uses four levels to define payers –Insurance Type  Broadest category  Affects Add/Edit insurance screen –Insurance Carrier  General carrier information  Assigns plans and financial classes

8. Creating a UB04 –Insurance Plans  UB04 format assigned at Plan level  All carriers have Inpatient and Outpatient plans  Billing Edits tied to assigned UB04 –Financial Classes  Control statement production  Used to assign Follow Up Queues

9. Billing Edits - Eclipsys Electronic System Checks Electronic System Checks –Is data there? –Is data formatted correctly ? Tied to UB04 format Tied to UB04 format Generic Edits Generic Edits Customized at Plan level Customized at Plan level

10. Billing Edits - Electronic Billing Electronic Billing Systems add edits Electronic Billing Systems add edits –More specific to payer –May be fixed through Electronic Billing System Medicare/Medi-Cal require more extensive edits Medicare/Medi-Cal require more extensive edits

11. Chargemaster Extensive database Extensive database –Service codes and descriptions –Medical coding –Charge amounts –Revenue codes –Major codes Complex formatting Complex formatting Restricted access Restricted access

12. Medical Coding Reduces services and procedures to codes Reduces services and procedures to codes –CPT, ICD-9, or HCPCS Facilitates reporting and benchmarking Facilitates reporting and benchmarking Based on physician documentation only Based on physician documentation only

13. Common Errors Errors Delay or Prevent Billing Errors Delay or Prevent Billing –Employment Status Missing –Billing Address Missing –Insurance Not Verified –Patient’s Address Not Verified Do It Right The First Time; Don’t Do It Over

14. Questions??