Uniform Bill Type of Bill

on Tuesday, 01 May 2018. All News Items

Worth Repeating

We hope our readers find our articles helpful in understanding the ins and outs of dealing with Medicare. We provide the latest updates on Medicare issues and dig deep into the more complex or unclear topics. Did you know all of our prior articles can be found under the Knowledge Base tab on our website at www.mmplusinc.com ? This page includes a search function that allows viewers to search by title, category, text keyword or date. One of our most popular prior articles, based on internet search traffic, is the “type of bill” article from 2014. Today, we are rerunning a slightly revised version of that article as a reminder of exactly what a type of bill is and the appropriate TOB for the various types and settings of healthcare.

A ‘type of bill’ designation is required on the institutional uniform billing form known as a UB-04 or CMS-1450. Chapter 25 of the Medicare Claims Processing Manual, section 70.1 describes the form as:

“… a uniform institutional provider bill suitable for use in billing multiple third party payers. Because it serves many payers, a particular payer may not need some data elements. The National Uniform Billing Committee (NUBC) maintains lists of approved coding for the form. Medicare Administrative Contractors servicing both Part A and Part B lines of business (A/B MACs (A) and (HHH)) responsible for receiving institutional claims also maintain lists of codes used by Medicare.”

The type of bill goes in field (FL) 4 on the UB-04. Type of bill consists of four digits, the first digit being zero. This leading zero is ignored by Medicare for processing and is usually dropped when discussing bill types. The second digit identifies the type of facility and the third classifies the type of care being billed.  For example, claims with a second digit of “1” are hospital claims, such as 011x or 013x.

Type of FacilityTOB CodeTOB Description
Hospital 011X Hospital Inpatient (Part A)
012X Hospital Inpatient Part B
013X Hospital Outpatient
014X Hospital Other Part B
018X Hospital Swing Bed
Skilled Nursing 021X SNF Inpatient
022X SNF Inpatient Part B
023X SNF Outpatient
028X SNF Swing Bed
Home Health 032X Home Health
033X Home Health
034X Home Health (Part B Only)
RNHCI 041X Religious Nonmedical Health Care Institutions
Clinic 071X Clinical Rural Health
072X Clinic ESRD
073X Clinic – Freestanding
074X Clinic OPT
075X Clinic CORF
076X Community Mental Health Centers
077X Federally Qualified Health Centers
Special Facility 081X Nonhospital based hospice
082X Hospital based hospice
083X Ambulatory Surgery Center
085X Critical Access Hospital

The fourth digit of the TOB indicates the sequence of the bill for a specific episode of care as defined below:

  • “0” indicates a non-payment/zero claim. For example, if a facility determines an inpatient admission is not medically necessary after discharge, they would first submit a no-pay/provider liable inpatient claim, a 110 TOB. After denial, they would then submit a Part B inpatient claim (TOB 121) to receive payment for the Part B services furnished.
  • “1” is for an admit-through-discharge claim.
  • “2” is the first interim claim in a series of claim when the patient is expected to remain in a facility for an extended period of time or is receiving outpatient recurring services, such as physical therapy.
  • “3” is a continuing claim in a series of claims.
  • “4” indicates the last claim in a series.
  • “5” is used as the last digit for late charges only claims.
  • “7” is a replacement claim to be used when a previously finalized claim needs to be rebilled entirely such as corrected or adjustment claims.
  • “8” is used to cancel a claim.

There are some additional fourth characters for special providers such as hospice and home health.

As usual with Medicare, nothing is as straight forward as it seems. Be sure to read the Medicare manual and other resources to ensure you are using the type of bill codes correctly.  For example, Medicare Claims Processing Manual, Chapter 1, section 50.2 discusses Frequency of Billing for Providers.

Article by Debbie Rubio

Debbie Rubio, BS, MT (ASCP), is the Manager of Regulatory Affairs and Compliance at Medical Management Plus, Inc.  Debbie has over twenty-seven years of experience in healthcare including nine years as the Clinical Compliance Coordinator at a large multi-facility health system.  In her current position, Debbie monitors, interprets and communicates current and upcoming regulatory and compliance issues as they relate to specific entities concerning Medicare and other payers.  You may contact Debbie at This email address is being protected from spambots. You need JavaScript enabled to view it. .

 

This material was compiled to share information.  MMP, Inc. is not offering legal advice.  Every reasonable effort has been taken to ensure the information is accurate and useful.

 

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