MEDICARE PART A UB FORM

 File in the UB 04 format 

 Type of bill 711 for RHC and 771 for FQHC 

 Enter actual charges, NOT THE ENCOUNTER RATE. 

 The charges must be rolled into 1 line item with the correct revenue code EXCEPT for G0402, G0438, G0439 

 Co-insurance/deductible is based on the total charge of professional services rendered. 

 Bill only one Medicare encounter per day for services rendered in the clinic 

 Must have a medically-necessary diagnosis

 A mental health visit AND an RHC encounter are payable on the same day. 

 Timely filing limits have changed to one year from the date of service.

REVENUE CODES

 The following Revenue Codes are used for Medicare Part A billing on the UB 04 format: 

 0521 Clinic visit at RHC by qualified provider 

 0522 Home visit by RHC provider 

 0524 Visit by RHC provider to a Part A SNF bed 

 0525 Visit by RHC provider to a SNF, NF or other residential facility (non-Part A) 

 0527 Visiting Nurse service in home health shortage area 

 0528 Visit by RHC provider to other non-RHC site (scene of accident) 

 Revenue code 0900 from both RHCs and FQHCs when billing for services subject to the Medicare outpatient mental health treatment limitation, and revenue code 0780 when billing for the telehealth originating site facility fee. 

OFFICE VISITS

 Established Patient 

 New Patient 

 Provider Based RHC submits the encounter under the CLINIC Medicare Part A number on the UB form 

 Independent RHC submits the encounter under the CLINIC Medicare Part A number on the UB form