Recent Articles
Should we read into changes in ’source of referral’ definition?
Q: Regarding “FL15-Source of Referral for Admission or Visit,” the definition in the UB-04 specifications is, “a code indicating the source of the referral for this admission or visit.” The definition in the UB-92 specifications, that we currently use, is “code indicating the source of this admission or outpatient registration.”
Is there a difference in how we should be using this field or not? Are we reading too much into the difference in verbiage?
A: The NUBC is currently reviewing the Source of Admission or Visit codes. There has been a great deal of confusion around the use of this data element, but it is becoming more important as pay-for-performance initiatives take hold.
The NUBC held a meeting on some proposed language changes for this field. We are planning to clarify how these codes should apply. The NUBC wants to include some further refinements to the proposed language changes for some of the codes and will be revisiting this issue at the May meeting.
At that time we hope to have final agreement on the approach. Fundamentally, we want the codes to represent the point of origin.
Editor’s note: George Arges, senior director of the American Hospital Association, answered this question.
Priority type of visit: Required for all patient types?
Q: Regarding the “FL14″ field for “Priority Type of Visit” on the UB-04 form, is it needed on all patient types? Or is it needed just for inpatient and emergency room visits?
A: This field is required for all inpatient claims; it is optional for outpatient reporting.
Editor’s note: George Arges, senior director of the American Hospital Association, answered this question.
Patient Access Advisor, March, 2007
Check out the March 2007 edition of Patient Access Advisor, which features:
- Auditing patient access: How one health system benefits from technology
- High-deductible health plans: How to sidestep your payer restrictions on up-front collections
- Watch out for limited benefits plans, identification plans
- Ease the flow: New position helps Pennsylvania emergency department run more smoothly
Patient flow coordinator job description
This tool will help you identify potential candidates for a new, unique position in your hospital.
Central registration auditor job description
The following is a central registration auditor job description.
UB-04: Nine or 10 characters for the Secondary Identifier field?
Q: The UB-04 requirements are only for nine characters in fl76-fl79 line 1, Secondary Identifier field. But the Michigan state license, which is used for Blue Cross Blue Shield of Michigan (BCBSM) and all of our commercial payers, is 10 characters long. Can you explain why this is?
A: You are correct in noting that the secondary identifier field in FL76-79 has room for only nine characters. The NUBC sought to provide a secondary identifier such as the UPIN or SSN/TIN number. We felt that the NPI should be used as the primary identifier – including using the NPI as a reference to any state licensure number. If the BCBSM and the commercial payers need to have the state licensure number always reported, the NUBC would be willing to examine a request from these organizations to accommodate such reporting. One way would be to utilize the Code-Code field FL81 – establishing a qualifier to denote Attending, Operating, or Other caregiver’s State Licensure number.
Editor’s note: George Arges, senior director of the American Hospital Association, answered this question. .
Is ‘reason for visit’ a required field?
Q: I am curious about “FL70 a,b,c, reason for visit.” Is this a required field for all payers?
A: This is a situational use field. It would beneficial to capture this information on a routine basis – simply because it does convey the medical reason or symptom the patient indicated when he or she presented to your facility. This could be helpful with EMTALA requirements to explain the basis for the emergency department visit.
Editor’s note: George Arges, senior director of the American Hospital Association, answered this question. .
Is “covered days” only a Medicare requirement?
Q: “Covered days,” which is currently FL7 on the UB-92 form, will be identified as a value code 80 on the UB-04. Is this only a Medicare requirement? Will commercial and Medicaid payers require us to complete the value code?
A: The reporting of the UB-92 covered days, non-covered, etc., only changes in the way one reports this information on the paper UB-04-it is now reported as a value code. In the value code section code, “80″ indicates that for electronic reporting continues to handle it the way you had done this before. Generally, these codes were created primarily for the Medicare program to track benefit days. We are not changing the usage requirements; it is possible that another health plan may want similar information reported. Your experience with the health plan should determine whether you need to report this information for them.
Editor’s note: George Arges, senior director of the American Hospital Association, answered this question.
Is it OK to submit the standard three-digit bill type on a UB-04 form?
Q: “Type of Bill” FL4 has been expanded to four digits on the UB-04 form. Are payers going to expect four digits or is it OK to only submit the standard three-digit bill type?
A: Although the NUBC recommended that for the paper UB report the “Type of Bill” with the leading zero and for the electronic transaction standard do not include the leading zero, initially it might be best not to include the leading zero. However, we would ask that as you make the necessary system modifications to your information systems, that you expand this field size to four characters to anticipate future assignment of this added character.
Editor’s note: George Arges, senior director of the American Hospital Association, answered this question.
Patient Access Advisor, February, 2007
Check out the February 2007 edition of Patient Access Advisor, which features:
- QA: Scoring method helps identify training needs, improve staff competency
- Strategies to hire the right quality assurance leader for your patient access staff, competency program
- How to find the right registrar: Tips to avoid hiring incompetent staff for your organization’s front door
- Using diversions in a different way
- Nonemergency surgical prepayments: How a consistent approach lightens the load for patients, providers