Form Question: 1500 vs. UB


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Good morning everyone,

I'm new to coding/billing in general, and am looking for an answer to what probably amounts to a very basic question.

I'm trying to determine the difference between the CMS-1500 and UB-04 forms and under which circumstances you should use one over the other. My current understanding is that the CMS-1500 are used for billing physician's services, where as the UB-04 are used for billing facility charges (in an ASC for example).

Currently, we bill both our physicians services and our ASC facility charges on a 1500 form, and everything seems to be fine. I'm trying to figure out of there is a benefit to billing on a UB-04 for the ASC, instead of using the 1500? My initial guess is that we can bill for HCPCS-II codes on a UB, whereas we cannot do so on a 1500?

Also, on a semi-unrelated note, can anyone point me to a nice training manual for coding/billing in general? The experience I have now is based on my work experience, which results in a lot of 'the way we've always done it' knowledge, and I feel like I am missing some pertinent basic information. I purchased a few of the study guides from AAPC, such as their CASCC, but found they assume a higher level of experience than I currently have. I'm hoping I can find a nice comprehensive manual that will take me from step 1 of layman through becoming proficient and knowledgeable on the subject.

Thanks for your help!


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Re: the books, you might consider taking a couple of courses at a local college or purchasing textbooks commonly used in college courses.

For billing, consider
Fordney, Insurance Billing for the Medical Office;
Beik, Health Insurance Today; or
Vines, Comprehensive Health Insurance.

For coding, consider
Buck, Step by Step Medical Coding;
Leon-Chisen, Faye Brown's ICD-9-CM Coding Handbook;
Schraffenberger, basic ICD-9-CM Coding;
Green, 3-2-1 Code It

A web search or Amazon search should turn up most of these.
I hope this helps.