Uniform Billing Form ye Institutional Providers
Iyo fomu yaBU-04 yokubhadhara yunifomu ndiyo yerineni yakatsvuka pamapepa machena mapepa ekutsvaga-shandiswa anoshandiswa nevanopa zvipo zvekubhadhara kudai. Kunyange zvazvo yakave yakagadzirwa neCenters for Medicare neMedicaid (CMS), yakave iyo fomu yakashandiswa inoshandiswa neinishuwarenzi dzose dzinotakura.
Komiti yeNational Uniform Billing Komiti uye American Hospital Association inogadzira uye inogadzirisa zvinyorwa zveHurumende UB-04 Electronic Data Set.
Vanoparidza Bhuku reBU-04.
Ndiani Anokwanisa Kubhadhara Zvikwereti Achishandisa UB-04?
Chero chero ani zvake anokwanisa kushandisa ur-UB-04 nokuda kwekudaidzira kwechiremba .
- Community community health centre
- Kunyatsoshandiswa kunze kwekugadziriswa kwekugadzirisa nzvimbo
- Chirwere chinopinda kuchipatara
- Kuguma-danho real disease chirwere
- Federally qualified health health center
- Histocompatibility laboratory
- Home health agency
- Hospice
- Chipatara
- Indian Health Services facility
- Organisation procurement organization
- Outpatient physical therapy services
- Occupational therapy services
- Hurukuro dzehutano hwehutano
- Chikamu chekuchengetwa kwehutano chisingabatsiri
- Rural health clinic
- Unyanzvi hwokurapa unyanzvi
Mazano Okugadzirira UB-04
Kuti uzadze fomu zvakarurama uye zvakakwana, chengeta zvinhu izvi:
- Tarisa nemubhadhari wega wega wega kuti uone kuti chii chinodiwa.
- Iva nechokwadi chokuti yese data yakapinda nenzira yakarurama uye yakarurama muminda yakarurama.
- Yakawanda mirayiridzo yevanorwara uye varwere vepachipatara vanofanana. Onai Bhuku Rekubhadhara Rokufananidza kwemashoko akajeka.
- Pinda mazano ehushuwarisi kusanganisira zita remurwere sezvarinoratidzika pa-inshuwarisi.
- Shandisa zvakakodzera kuongororwa zviratidzo (ICD-9 kana ICD -10 ) uye maitiro emitemo (CPT / HCPCS) uchishandisa modifiers kana zvichidiwa.
- Shandisa kero chaiyo yebasa renzvimbo yebasa renzvimbo.
- Usakanganwa kubatanidza NPI iyo inoratidzwa.
Dzimwe mirayiridzo yakazara inogona kuwanikwa pa www.cms.gov kana www.nubc.org
Minda yeB-04
Pane 81 minda kana mitsara paB-04 inonzi inonzi locator kana "FL". Chimiro choga choga chinzvimbo chinogadzirisa chinangwa chakasiyana.
- Fomu mudzidzisi 1 Zita rekupa mubhadharo, kero yemugwagwa, guta, nyika, zip, foni, fax, uye kode yenyika
- Fomu mudziyo 2 Mubhadharo wekubhadhara mubhadharo-zita, kero, guta, nyika, zip, uye ID kana zvakasiyana nemunda 1
- Fomu mushaya 3 Mutevedzeri wekutora nhamba uye nhamba yezvokurapa nhamba yeimba yako
- Fomu mudzidzisi 4 Rudzi rwebhadhiro (TOB) Iyi iyi nhamba yechina yenhamba kutanga ne zero, maererano neNational Uniform Billing Committee mirayiridzo.
- Fomu mushaya 5 Federal tax number yeunzvimbo yako
- Fomu mudziyo 6 Nheyo kubva uye uye kuburikidza nemazuva ebasa rakavharwa pamutsara, muMMDDY format.
- Fomu mushaya 7 Kwete kushandiswa
- Fomu mutevedzeri 8 Zita revarwere muChirungu, Kutanga, MI maitiro
- Fomu mutevedzeri 9 Murefu wemugwagwa kero, guta, nyika, zip, uye kode yenyika
- Fomu mushaya 10 Murefu wokuberekwa muMMDDCCYY mafomu
- Fomu mushaya 11 Murembere wechirwere - M, F, kana U
- Fomu mutsva 12 Gwaro rekugamuchira mu MMDDCCYY mafomati
- Fomu mudziyo 13 Nguva yekugamuchira inoshandisa madijiti maviri-nhamba kubva 00 kusvika pakati pousiku kusvika 23 kusvika 11 dzemasikati
- Chikwata chekuwana 14 Rudzi rwekushanya: 1 rwekukurumidzira, 2 yekukurumidzira, 3 yekusarudza, 4 yechangoberekwa, 5 yekushungurudzika, 9 kuti uwane ruzivo rwakasawanikwa.
- Fomu mudzidzisi 15 Chinangwa chekubva (chikonzero chekugamuchira)
- Fomu mudzidzisi 16 Kubudisa awa mufananidzo wakafanana segamba 13.
- Chikwata chekuwana 17 Kubudisa chimiro uchishandisa nhamba mbiri-nhamba kubva mubhuku reNUBC.
- Fomu mudzidzisi 18-28 Chimiro chinoshandisa kushandisa nhamba mbiri-nhamba kubva kumubhuku weNUBC kusvika kune zviitiko zvinomwe.
- Fomu mudziyo 29 Njodzi yehurumende (kana inoshandiswa) code yenyika mbiri
- Fomu mushaya 30 Kwete kushandiswa
- Fomu mutsva 31-34 Chiitiko chemashoko uye zuva rinoshandisa bhuku reNUBC yemitemo
- Fomu mutsva 35-36 Chiitiko chepakati podhidhi uye mazuva muMMDYY format
- Fomu mushaya 37 Kwete kushandiswa
- Fomu mushaya 38 Zita remutungamiri wekodzero uye kero
- Fomu mutsva 39-41 Kukosha mazano nemari yemamiriro ezvinhu chaiwo kubva mubhuku reNUBC
- Fomu mudziyo 42 Revenue mazano kubva mubhuku reNUBC
- Fomu yekuwana tsanangudzo tsanangudzo yekodzero yemubhadharo, nhamba yekutsvakurudza inoshandiswa (IDE), kana Medicaid rebate rebate NDC (yenyika yekodhi yekodhi)
- Fomu mudziyo 44 HCPCS (Healthcare Common Procedure Coding System), nzvimbo dzekugara, HIPPS
- Fomu mutsva 45 Dhiabhorosi
- Fomu mushaya 46 Mapoka ehurumende
- Fomu mutsva 47 Zvose zvikwereti
- Fomu mudzidzisi 48 Zvisina kuvharwa
- Fomu mushaya 49 Page_of_ uye zuva rekusika
- Fomu mudzidzisi 50 Payer Identification (a) Primary, (b) Sekondari, uye (c) Gumi
- Fomu mutsva 51 Hurongwa hwehutano ID (a) Nheyo, (b) Sekondari, uye (c) Gumi
- Fomu mudzidzisi 52 Kusunungurwa kwemashoko (a) Primary, (b) Sekondari, uye (c) Nepamusoro
- Fomu mudzidzisi 53 Basa rezvibatsi (a) Primary, (b) Sekondari, uye (c) Gumi
- Chikwata chekuwana 54 Paizobhadhara (a) Pokutanga, (b) Sekondari, uye (c) Gumi
- Chikwata chekuwana 55 Chiyero chawakafanirwa (a) Chekutanga, (b) Sekondari, uye (c) Chepamusoro
- Fomu mushaya 56 Kubhadhara mutapi wenyika muperekedzi mucherechedzo (NPI)
- Fomu mudzidzisi 57 Mamwe mupiirii ID (a) Primary, (b) Sekondari, uye (c) Gumi
- Fomu yekuwana nzvimbo 58 Zita reAisitikiti (a) Primary, (b) Sekondari, uye (c) Gumi
- Fomu mutsva 59 Ukama hwevarwere (a) Pokutanga, (b) Sekondari, uye (c) Gumi
- Fomu mudzidzisi 60 Nhamba yakasiyana-siyana yeAIDS inotarisirwa (a) Nheyo, (b) Sekondari, uye (c) Gumi
- Fomu mutsva 61 Inzwi reboka reInishuwarenzi (a) Primary, (b) Sekondari, uye (c) Gumi
- Fomu mudzidzisi 62 Inhengo yeInishuwarenzi nhamba (a) Primary, (b) Sekondari, uye (c) Nepamusoro
- Fomu mutevedzeri 63 Kushandiswa kwemvumo yekurapa (a) Nheyo, (b) Sekondari, uye (c) Gumi
- Chikwata chekuwana nhamba 64 Nyaya yekuchengetedza Nyaya inonziwo iyo Inhamba yekudzivirira nhamba (a) Primary, (b) Sekondari, uye (c) Nepamusoro-soro
- Fomu mutsva 65 Nheyo yevashandi vanochengetwa (a) Nheyo, (b) Sekondari, uye (c) Gumi
- Fomu mutsva 66 Kuongorora zviratidzo (ICD)
- Fomu mudzidzisi 67 Mazano ekuongorora zviratidzo, mamwe anoongorora uye aripo pane zviratidzo zvekugamuchira (POA)
- Fomu mudzidzisi 68 Haisi kushandiswa
- Fomu mutevedzeri 69 Kugamuchira zvirwere zvinowanikwa
- Fomu mutsva 70 Murwere ane chikonzero chekushanya nhamba
- Chikwata chekuwana 71 Chinangwa chekubhadhara system (PPS) code
- Fomu mudzidzisi 72 Chikonzero chekunze chekombiyamu yokukuvadza uye POA chiratidzo
- Fomu mudzidzisi 73 Kwete kushandiswa
- Fomu mudzidzisi 74 Mamwe mapurogiramu epurogiramu uye zuva
- Fomu mutsva 75 Kwete kushandiswa
- Fomu mudziyo wekuwana 76 Kusangana nomubatsiri NPI, ID, vhidhiyo, uye yekupedzisira uye zita rokutanga
- Fomu mutevedzeri 77 Chiremba wekushanda NPI, ID, zivo, uye yekupedzisira uye zita rokutanga
- Fomu mudzidzisi 78 Mumwe mupi anopa NPI, ID, zivo, uye yekupedzisira uye zita rokutanga
- Fomu mudzidzisi 79 Mimwe mupiro NPI, ID, zivo, uye yekupedzisira uye zita rokutanga
- Fomu mudziyo 80 Mashoko
- Fomu mushaya 81 Taxonomy code and qualifier