UB-04 and CMS 1500

UB-04, also referred to as CMS-1450, is a form that used for billing of medical and
mental health claims by institutional providers such as hospitals and nursing facilities.
Institutional providers use UB-04 form to submit claims for services such as surgery,
laboratory, radiology, and other services (Cross, 2015).

UB-04 and CMS-1500 are similar in appearance. However, there are significant
differences between the two forms. While UB-04 is used by institutional providers, CMS-
1500 is used by individual providers, such as physicians and nurses to process medical claims
for services that they provide to patients (Cross et al., 2015). The services can be provided
either in their private facilities or in institutions. Thus, the main difference between UB-04
and CMS-1500 is who uses them form. UB-04 is used by institutions while CMS 1500 is
used by individual healthcare providers.

With regards to Medicare, UB-04 is used for submitting changes under Medicare Part
A. Medicare Part A covers areas such as surgery, lab tests, and in-patient hospital care. CMS-
1500, on the other hand, is used for submitting charges under Medicare Part B. Medicare Part
B mainly covers outpatient services, such as x-rays and routine preventive care.

Whether it is UB-04 or CMS-1500, it is important to accurately fill the forms. This is
because the forms are used for processing medical claims of patients. If there are inaccuracies
in the filling of the forms, the healthcare provider may find it difficult to receive
reimbursement from the insurance companies (payers). For instance, there may be delays in
processing of the payments or the payments may be denied altogether. Thus, accurate filling
of the forms ensures that healthcare providers receive full reimbursement for their services on
time.

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References

Cross, A. B., Shield, B., Healthwise, S. H., Plan, H. I., & Connect, H. C. (2015).
Reimbursement Policy April 2016. Policy, 6(063).