Home Health & Hospice Week

Get ready for more coding possibilities.

Now's the time to make sure your software is ready to handle the new UB-04 claim form or risk denials starting in May.

Deadline: By May 23, providers using institutional paper claims must discontinue using the UB-92 and start using the new UB-04 form to accommodate the new National Provider Identifier (NPI) numbers.

Update: Because of the number and types of changes that the new UB-04 includes, your billing software programs will need updating to correctly print your claims.

Best bet: Contact your software vendor as soon as possible to make sure it is ready to comply with the deadlines if you are transmitting your claims electronically, says Felice Landry, senior billing consultant with Reingruber & Co. in St. Petersburg, FL.

Find out what your vendor intends to do to address the changes and when you can expect upgrades to occur. Get the timeline from your vendor in writing to ensure that it delivers when it says it will.

Good news: If you're using the fiscal intermediary's free software, it will be compliant with the deadlines, Landry says.

Start Using The UB-04 Early

You aren't required to start using the UB-04 until May 23, but you can start submitting claims with it as early as March 1. During the transition period from March 1 to May 22, contractors will accept both current and revised forms, meaning that you can use either the UB-04 or the UB-92, according to the Centers for Medicare & Medicaid Services.

Reminder: After May 22 you must use the new UB-04 only, including for any resubmission of bills submitted in a different format earlier.

Try to start testing the new form as early as possible so you can keep an eye out for any unusual errors, Landry urges. "Just like when you replace software at home, you need to pay attention to those little bugs," she urges.

And if you find errors, be sure to share that information with your fiscal intermediary, Landry advises.

Warning: Make sure your new 10-digit NPI matches your current provider number. If you don't test the form to check this before May 23, all of your claims will be rejected, says Landry. "And that means no money!"

To prepare for the transition, Darlene Greenhill, consultant with Mauldin & Jenkins in Atlanta, GA, suggests that you:

• Review Transmittal 1104 at www.cms.hhs.govtransmittals/downloads/R1104CP.pdf to see the new instructions and format;
• Be aware of the transition dates;
• Make sure you have your NPI number; and
• Compare a hard copy of the UB-92 with the UB-04 to see the differences.

Form May Change Diagnosis Coding

Here's what to expect in the new claim form:
 
1. Some things staying the same. Many of the data locations have changed, but most of the data usage descriptions and allowable data values have not changed, says Landry. And while the UB-92 has 86 field locators, the UB-04 has only 81.

2. More room. After field locator 56, which provides space for the new NPI, the most noticeable change on the UB-04 is the expansion of the diagnosis code field (67) to accept 18 ICD-9 codes. That gives you room to report up to eight additional diagnosis codes.

A twist: Even though the diagnosis code field has been expanded, Medicare will ignore these eight new spaces, according to CMS Transmittal 1104.

Still, you should make sure you're putting in correct data anyway--wrong data can create processing problems, Landry cautions. These spaces should hold the principal diagnosis along with the diagnoses of other pertinent conditions that existed at the time of admission or developed subsequently and affected treatment or the patient's length of stay, she counsels.

3. Fewer forms. The UB-04 will answer the needs of many health insurers, so it can be used by more payers. This new form will eliminate the need for more claim forms, Landry hopes.

4. Flexibility. The UB-04 can accept ICD-10 codes, so there won't be a need to transition to yet another new claim form when the ICD-10 diagnosis codes eventually take effect.