Room and Board (R&B) Services Billed on UB-04 Claim Form, CR 20532

June 9, 2014

We had previously discovered an issue where the system is not paying more than one R&B on the same claim if you are using the same revenue code. The first R&B line is paid, but subsequent lines with the same revenue code are denied as duplicate. This occurs when the date of service is not applied at the line level.

While working on the issue described above, we also identified an issue where claims that should deny are paying in error. This occurs when the inappropriate Type Of Bill (TOB) frequency and patient status codes are used. Claims in the following two situations should deny, but are paying in error:

  1. The R&B units billed do not match the claim date span based on the frequency of the TOB.
  2. Based on the claim date of service, the R&B units billed do not match the TOB frequency and the discharge status.

Once the system update is complete, R&B claims billed inappropriately on the UB-04 claim form will be denied.

Please review your current system set up to ensure that the TOB frequency and patient status codes reflect the R&B units you are billing. The frequency code is the last digit of your TOB.

The following codes are the most frequently used:

1 = admit through discharge claim 2 = interim – first claim 3 = interim – continuing claim 4 = Interim – last claim

For a complete listing, please refer to the National Uniform Billing Committee UB-04 Specification Manual.

Patient status codes indicate the disposition, or discharge status of the patient at the time of the last service for the period covered on the bill, as reported in FL6, Statement Covers Period, or Loop 2300, DTP03 for 837 electronic claims transactions.

Example of an incorrect patient status code and TOB frequency combination:

When using a patient status code of 30, it means the patient is still an inpatient. The combination of patient status code 30 and TOB frequency of 1 or 4 is incorrect. This example is causing incorrect payments on R&B lines.

We will notify you when this issue is corrected.