CMS form 1450 (UB04)
The CMS1450/UB04 is a uniform billing form used by institutional providers for paper submission of claims.. Details on the form and CMS instructions for completion are found in Ch 25 of the CMS Claims processing manual. www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c25.pdf For electronic submissions institutional providers use the ANSI ASC X12N 837I. CMS Medicare Learning Network, Medicare Billing: Medicare Billing: 837I and Form CMS-1450ANSI https://www.cms.gov/Outreach.../Medicare.../837I-FormCMS-1450-ICN006926.pdf
A hospital or skilled nursing facility stay that meets the requirements for Medicare coverage. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS012673.html
Medicare payment system that directly pays participating providers. Also referred to as “traditional Medicare.”
Final Action Claim
The version of a claim where all adjustments are resolved and CMS’s final action is recorded.
ICD: International Classification of Diseases
Standard coding set for diagnoses and procedures. ICD-9 was replaced with the implementation of ICD-10 on Oct 1, 2015.
Medicare Severities-Diagnosis Related Group
Medicare-covered hospital stays are assigned to an MS-DRG for payment under the Medicare Inpatient Perspective Payment System (IPPS)