PrognoCIS UB-04 Functionality Designed to Empower Rural Health Providers

March 30th, 2016 - By Kevin V. Nguyen

Rural health providers (RHPs) face a unique set of challenges when providing health care to their community. RHPs are often the only source of medical aid in vast regions of the country. They provide a level of care on par or greater to hospitals in urban areas. The National Rural Health Association (NRHA) provides some statistics that may surprise you:

  • Only about ten percent of physicians practice in rural America despite the fact that nearly one-fourth of the population lives in these areas.
  • Medicare payments to rural hospitals and physicians are dramatically less than those to their urban counterparts for equivalent services. This correlates closely with the fact that more than 470 rural hospitals have closed in the past 25 years.

The challenges to rural health care are often overlooked. Not only is it harder for patients to receive treatment in rural areas, but providers also receive less for the same services. Luckily, the government provides a way for RHPs to receive financial incentives: the UB-04 claims form. A UB-04 is a way providers can bill as a hospital for the services they perform, leading to better reimbursement and financial incentives. It’s vital for RHPs to use the tools the government provides to get the level of reimbursement they deserve.

Here we show you what the UB-04 does, and how PrognoCIS helps facilitate UB-04s through our electronic health record (EHR) software.

UB-04 and Rural Health Providers

Rural health providers often encounter situations requiring versatility and flexibility. Many rural areas lack adequate facilities and specialized medical services often found in urban areas. As such, RHPs are called on to become jacks-of-all-trades—carrying out medical procedures usually performed by dedicated medical staff. Rural health providers play a vital role in the rural community because they take on the services a larger hospital would normally perform. To recite the statistic by the NRHA, “Only about ten percent of physicians practice in rural America despite the fact that nearly one-fourth of the population lives in these areas.” Rural health providers should be able to reward for their services just as a hospital would.

This is where UB-04s come into the picture.

UB-04 (CMS-1450) is a claim form that institutional providers (hospitals) submit as a reimbursement claim for medical expenses. Non-institutional providers such as family doctors or specialists fill out the CMS-1500 form for the same purpose.

How does this affect RHPs?

Because RHPs perform the institutional services that hospitals normally do, they may file for reimbursement claims as a hospital. This gives RHPs the same financial incentives hospitals do, greater incentives that non-institutional providers. RHPs play a huge role in taking care of rural communities, and UB-04s help them benefit from their services.

PrognoCIS’ UB-04 Capabilities

PrognoCIS understands the role rural health providers play in their communities. Our EHR is customized to handle the needs of RHPs looking to file insurance claims UB-04s or any other classifications in between. Here we show how to file an Encounter as Institutional, Professional, and Institutional, or Rural Health Type.

PrognoCIS Claims Type

We also support the ability to create a claim under the UB-04 (and all the combinations) type.

Filing a UB-04 Claim with PrognoCIS

Rural health providers are instrumental in providing care to lower-income areas. They are often the only bastion of medical care in areas that sorely need it. At PrognoCIS, we believe UB-04s are vital in providing rural health providers adequate reimbursement for the services they provide to their community.

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