Hospital Billing

Hospital Billing Help on the Internet:

I found the information on MB-GUIDE an excellent tutorial source for help understanding and filling out the UB-04 (CMS-1450) Claim Form for hospital billing. If you prefer a step-by-step approach to filling out the form, it can be found here.

You can find an amazing auto-play tutorial on the UB-04(CMS 1450) that I love on Pearson

General Hospital Billing Tips:

• Medicare 72-Hour Rule. When filing Medicare hospital claims, the 72-hour rule applies. The 72-hour rule states that if a patient receives any treatment related to the inpatient admission, such as diagnostic labs, x-rays, medical equipment, and/or any outpatient services within 72 hours of admission to a hospital (3-day payment window), then all such services are bundled with inpatient service claim if these services are related to the admission. It is important to note that the 72-hour rule applies only to Medicare. Other insurance companies do not cover preadmission labs, x-rays, medical equipment, and so on within 24 hours of hospital admission.
• Rules for Coding Inpatient Diagnoses. Coding inpatient and outpatient cases can differ. One important difference is how uncertain diagnoses are coded. For inpatient cases, code all "rule out," "suspected," "likely," "questionable," "possible," or "still to be ruled out" as if it existed. In addition, the following rules should be noted about the principal diagnosis:
• Codes for signs and symptoms of ICD-10CM are not reported as principal diagnosis.
• When two or more conditions meet the definition principal diagnosis, either condition may be sequenced first unless otherwise indicated by the circumstances of admission or the therapy provided.
• When a symptom is followed by a contrasting comparative diagnosis, sequence the symptom code first.

For complete instructions and guidelines to fill out a UB-04 (CMS-1450) Paper or Electronic Claim Form consult the medical hospital manual and the local UB-04 (CMS-1450) manual.

Hospital Billing Life Cycle 

Diagnosis-Related Group (DRG). A diagnosis-related group, also known as a DRG, is a prospective payment structure on which hospital fee reimbursements are based. The DRG groups diseases, possible related diseases and treatment into a code, which then produces a relative weight for reimbursement. Here is a link to a video to help you understand DRGs.
Medicare Severity Diagnosis-Related Group (MS-DRG). To obtain information on MS-DRG, go to the Federal Register's Website each October 1st for updates.

*find more Web resources for hospital billing on the Internet Resources tab.

Works Cited:
Fordney Insurance Handbook for the Medical Office