Hospital CPT Coding

The National Uniform Billing Committee (NUBC) was brought together by the American Hospital Association (AHA) in 1975 and it includes the participation of all the major national provider and payer organizations. The NUBC was formed to develop a single billing form and standard data set that could be used nationwide by institutional providers and payers for handling health care claims.

It wasn’t until 1982, after many years of debate and discussion on very technical data and policy issues, that the NUBC voted to accept the UB-82 and its associated data manual for implementation as a national uniform bill. Each of the represented organizations, including Medicare, expressed their support of the UB-82 data set. This came after several earlier versions of a uniform bill were developed and implemented with varying degrees of success.

Before the formation of the NUBC, the AHA had worked closely with the Healthcare Financial Management Association and the federal government to develop a uniform hospital bill. Between 1968 and 1972, thirteen different form designs were developed and discarded as unsatisfactory. The fourteenth version was field tested in Georgia in 1973, modified again, and introduced for a second trial in Wyoming. The Health Care Financing Administration (HCFA) agreed to participate in a five state pilot test of this latest version, known as the UB-16-78. An independent consultant evaluated this pilot project against the uniform bill used in New York State the UBF-1. Because of this evaluation and the subsequent deliberations of the NUBC, the UB-82 emerged as the uniform bill endorsed by the members of the NUBC. The UB-82 format and data specifications were finalized at the May 1982 NUBC meeting. The focus then shifted to the state level for implementation of the UB-82. Consequently, State Uniform Billing Committees (SUBC’s) were created to handle state implementation and to disseminate state UB-82 manuals, which reflect the national guidelines and unique state billing requirements. Virtually all states adopted the use of the UB-82 data set specifications.

Data Specifications

In determining the data to be included, the NUBC strives to balance the need for the information against the burden of providing that information. In essence it applies the administrative simplification principles mentioned in the recently enacted Health Insurance Portability and Accountability Act of 1996. Data elements identified as necessary for claims processing are, in most cases, assigned designated spaces on the form. The designated spaces are referred to as Form Locators and each one has a unique number. Other elements that are occasionally needed are incorporated into general fields that utilize assigned codes, codes and dates, and codes and amounts. This built-in flexibility of the data set is intended to promote the greatest use of the data set and to eliminate the need for attachments to the billing form. The data specifications manual seeks to identify the national requirements for preparing Medicare, Medicaid, OCHAMPUS, BCBS, and commercial insurance claims.

When the NUBC established the UB-82 data set design and specifications, it also imposed an eight-year moratorium on changes to the structure of the data set design. In light of the expiration of the moratorium, the NUBC embarked on a process to evaluate how well the UB-82 data set performed. After numerous state surveys, the NUBC sought to implement improvements to the UB-82 design. Consequently, the UB-92 was created, incorporating the best of the UB-82 along with other changes that further improve on the previous data set design. These improvements further reduce the need for attachments. Today the UB-92 is the “de facto” institutional claim standard. Today, more than 98% of hospital claims are submitted electronically to the Medicare program. Overall, more that 80% of all institutional claims are submitted electronically.

Role of the NUBC

With the data set operational, one of the NUBC’s major roles is to maintain the integrity of the UB-92 data set. In addition, the NUBC serves as the forum for discussions that lead to mutually agreed data elements for the claim as well as the data elements for other claim related transactions.

Over the years, the NUBC has realized that the UB data set has become more than a billing instrument. It is also used by many others, including public health and health researchers, as a tool to gauge the delivery of health care services to patients. Therefore, the data set has broad policy implications for shaping the future of our health delivery system. Recently, the NUBC increased it membership to include the public health sector as well as the electronic standards development organizations. The final regulations from the Health Insurance Portability Act of 1996 will include a prominent role for the NUBC. The role will be that of helping to define the data content associated with each of the electronic transactions mentioned in the legislation.

© Copyright 1999 American Hospital Association
Copyright for the members of the National Uniform Billing Committee (NUBC) by the American Hospital Association (AHA).