What document is used for facility/hospital inpatient and outpatient institutional claims?

• A. CMS-1500 (HCFA 1500) form
• B. Electronic UB-04 form
• C. 837I electronic claim form
• D. UB-04 (CMS-1450) claim form

Answer: (D)

In facility-based billing, the document used for inpatient and outpatient institutional claims is the UB-04 form, also known as CMS-1450. This form is specifically designed for institutional services, capturing essential details like admission and discharge dates, type of bill, and the diagnoses and procedures tied to hospital care. The CMS-1500 is meant for professional services provided by clinicians (not facilities), while the electronic counterpart for transmitting institutional claims is the 837I, which is the electronic format that corresponds to UB-04. So, for the actual claim document used by hospitals on paper, the UB-04 (CMS-1450) is the correct choice.