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healthcare finance
Discuss the primary differences between the CMS-1500 form and the UB-04 form.
Find an article that discusses the major billing errors on these forms and why this is significant. Briefly discuss the article.
Discuss the ways in which health care organizations can avoid some of these errors.
Your initial response should be 150 to 300 words in length and include at least one academic source that is properly cited.
Here is the article
Sculley, M. (2021, January 20). 10 Common Medical Billing Mistakes That Cause Claim Denials – Part 1. PracticeSuite. https://practicesuite.com/blog/10-common-medical-billing-mistakes-that-cause-claim-denials-part-1/.
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Healthcare finance
In any medical billing company for different healthcare providers, understanding which forms to use is the first step towards filing a successful claim. The UB-40 and the CMS-1500 are the most common forms for submitting reimbursement claims to insurance companies. Usually, physicians who have a private practice while still working in a medical facility rely on the CMS-1500 form to bill for their services. On the other hand, medical facilities including hospitals and outpatient facilities rely on the UB-04 for their claims and may include services such as radiology and laboratory. In addition, while the CMS-1500 form comprises charges under Medicare Part B, the UB-04 focuses on those under Medicare Part A.
In an article by Sculley (2021), there exist several billing errors on forms such as the UB-40 and the CMS-1500. Some of the highlighted errors in the article include missing claims, non-specific coding, not filing claims on time, incorrect patient identifier information, and coding issues. On missing information, for instance, a physician can fail to include things such as the date of the accident, date of onset, and date of a medical emergency. Such errors are critical since they determine denial or acceptance of claims. Any claim containing any of the listed errors leads to automatic claim denial. Sometimes, inflation of medical bills amounts to fraud leading to legal consequences.
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Healthcare organizations have a role to play in avoiding billing errors. For example, on missing information on the claim, the hospital should scrutinize every claim for missed fields and attach all the required supporting documentation (Sculley, 2021). According to Klinger (2019), payors, patients, and healthcare providers should collaborate to improve healthcare by supporting technologies that focus on improving the accuracy of medical bills. In most cases, patients remain the most vulnerable since they have to pay hefty medical bills.
References
Klinger, D. (2019, March 15). Medical Billing Errors are Alarmingly Common—and Patients Are Paying the Price. https://www.hcinnovationgroup.com/finance-revenue-cycle/article/21080693/medical-billing-errors-are-alarmingly-commonand-patients-are-paying-the-price
Sculley, M. (2021, January 20). 10 Common Medical Billing Mistakes That Cause Claim Denials – Part 1. PracticeSuite. https://practicesuite.com/blog/10-common-medical-billing-mistakes-that-cause-claim-denials-part-1/.
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