Question

When billing Rural Health Clinic services on a UB-04/837-I, specific CPT codes are collapsed into a single revenue code (520 or 521). Even though codes are collapsed into a single revenue code, it is still crucial to:

a) Attach copies of the patient's insurance card
b) Include a detailed breakdown of the provider's qualifications
c) List the appropriate CPT codes as part of the documentation
d) Submit a separate paper claim for each service provided

Answer 1

Correct billing for Rural Health Clinic services on a UB-04/837-I requires listing the appropriate CPT codes within the documentation, to ensure clarity and auditability in the fee-for-service billing process.

Step-by-step explanation:

When billing Rural Health Clinic services on a UB-04/837-I, even though specific CPT codes are collapsed into a single revenue code such as 520 or 521, it is still crucial to list the appropriate CPT codes as part of the documentation. This practice ensures that the services provided are clearly represented and can be appropriately tracked and audited. It maintains the integrity of the billing process by providing detail on the individual services that compose the single revenue code bundle. In contrast, options such as attaching copies of the patient's insurance card, including a detailed breakdown of the provider's qualifications, or submitting separate paper claims for each service provided are not directly related to the coding and review process of the billing.

In relation to health financing systems, this aligns with a fee-for-service model, where providers are reimbursed based on the services they render, as opposed to HMOs, which operate on a per-patient reimbursement model. Understanding the differences can help with navigating billing processes and addressing issues like adverse selection in insurance markets.