Which form is used for institutional claims?

• A. CMS-1500
• B. HCFA-1500
• C. CMS-1450
• D. UB-04

Answer: (D)

Institutional billing uses the UB-04 form, also called CMS-1450. This form is designed for facility claims from hospitals, skilled nursing facilities, and similar providers, covering both inpatient and outpatient services. It includes data elements like type of bill, patient control number, admission and discharge dates, discharge status, and revenue codes to itemize services by department. The CMS-1500 (formerly HCFA-1500) is the form used for professional or non-institutional claims by individual practitioners. So, for institutional claims, the appropriate form is UB-04 (CMS-1450).