Question

The standard claim form used for billing by hospitals, nursing facilities, and other inpatient services is typically:

a) CMS-1500
b) UB-04 (CMS-1450)
c) ADA Dental Claim Form
d) HIPAA 270/271 Transaction Set

Answer 1

The UB-04 (CMS-1450) form is the standard billing claim form used by inpatient services like hospitals, which corresponds with Medicare Part A coverage that includes hospital charges. Outpatient services are billed using the CMS-1500 form and relate to Medicare Part B, optional insurance for non-hospital healthcare costs.

Step-by-step explanation:

The standard claim form used by hospitals, nursing facilities, and other inpatient services for billing is the UB-04 (CMS-1450) form. This form is a requirement for the billing of medical and mental health claims within the Medicare system. In contrast, the CMS-1500 form is used by individual clinicians and therapists to bill Medicare for outpatient services. Medicare itself is divided into Parts A and B, with Part A covering some hospital charges and is funded by payroll deductions and matching contributions from employers. Patients are responsible for a deductible and copayments. Part B, on the other hand, is an optional insurance system for covering healthcare costs outside of hospital stays, such as physician services and outpatient visits. Patients pay a monthly fee, deductible charges, and copayments for Part B coverage, with the government covering about three-fourths of the costs.