What goes in box 51 on UB04?
How Does Medicare pay inpatient claims?
What is the inpatient place of service code?
| Place of Service Code(s) | Place of Service Name |
|---|---|
| 21 | Inpatient Hospital |
| 22 | On Campus-Outpatient Hospital |
| 23 | Emergency Room – Hospital |
| 24 | Ambulatory Surgical Center |
How do I check my ED claim?
How is a Medicare claim submitted?
Does Medicare cover ambulance?
The callout and use of an ambulance is not free-of-charge, and these costs are not covered by Medicare. In NSW, ambulance cover is managed by private health funds.
What is the place of service?
What is the difference between place of service 19 and 22?
What is place of service code 19?
File a complaint (grievance)
Find out how to file a complaint (also called a "grievance") if you have a concern about the quality of care or other services you get from a Medicare provider. Contact your State Health Insurance Assistance Program (SHIP) for local, personalized Medicare counseling.
File a claim
Get information on how and when to file a claim for your Medicare bills (sometimes called "Medicare billing"). You should only need to file a claim in very rare cases.
Check the status of a claim
Check your claim status with your secure Medicare account, your Medicare Summary Notice (MSN), your Explanation of Benefits (EOB), Medicare's Blue Button, or contact your plan.
File an appeal
How to appeal a coverage or payment decision made by Medicare, your health plan, drug plan or Medicare Medical Savings Account (MSA) Plan.
Your right to a fast appeal
Learn how to get a fast appeal for Medicare-covered services you get that are about to stop.
Authorization to Disclose Personal Health Information
Access a form so that someone who helps you with your Medicare can get information on your behalf.
What is the HCPCS code?
The HCPCS is composed primarily of CPT-4 codes developed by the American Medical Association, with additional codes specific to CMS. Each HCPCS code on the carrier bill must be accompanied by a diagnosis code (ICD9, ICD10), providing a reason for the service.
What is a DME file?
The Durable Medical Equipment (DME) contains final action claims data submitted to Durable Medical Equipment Regional Carriers (DMERCs). Some of the information contained in this file includes diagnosis, (ICD-9 or ICD-10 diagnosis), services provided (HCFA Common Procedure Coding System (HCPCS) codes), dates of service, reimbursement amount, DME provider number, and beneficiary demographic information. Claims for DME services that are processed by a carrier will be found in the NCH file. Claims for DME services that are processed by DMERCs will be found in the DME file. For example, claims for oral equivalents of IV chemotherapies will be found in the DME file.
Purpose
This article provides guidance on how to identify hospital emergency room claims from the Medicare files.
Article Information
ResDAC would also like to acknowledge Deb Caldwel, Kelly Merriman and Sara Durham for assistance with this article.
