The health care institutions that used uses the two forms are inpatient, outpatient care, and ambulatory surgical centers. Here is a great example, An individual presents at the local ambulatory care center anticipating neck surgery. The patient has both Medicare part A and B. Part A used form PUB-04 and Medicare part B used form for SMS-1500 for the physicians billing and after care. The two form differ from each other by the PUB-04 is used by hospital and outpatient services and also summated by third party payers. SMS-1500 is used for physician billing.
The patient information, codes, and insurance information are shown as follows on the SMS- 1 500 form the patient demographics, date of birth, gender. Type of insurance and identifying numbers. They asks if the patient condition was related to an accident. On the form it asks for date of incident. On this form it asks for diagnosis code then date of service the procedure was preformed, place of service the CAP/HASPS and modifier. Asks for charges days and units. Asks for patient number. Has a box in the bottom for doctors signature, service facility location, and billing status.
BUBO form has minor information about patient demographics. Asks for date of birth and gender. Has admitting and condition codes. Has a big section asking for description HASPS codes. Below that asks for insurance information. Asks for admission diagnosis codes and patient reason diagnosis codes. Also asks for Procedure diagnosis codes. The impact on reimbursement if the information entered on the form is incomplete or incorrect would be that the claim for would be denied.