Deck 8: Patient Information

Question 1

Answer the following questions based on the top portion of the UB-04 form shown here.
a.Given the data shown, do you think the TOB on the claim is 011X or 013X?_____
b.Are the patient and the insured the same or different?______
c.In what month was the patient born?____
d.Was the patient admitted as an emergency case, or did she choose the date of her admission?______
e. Where did the patient come from before being admitted?_____
f. Was the patient discharged in the morning or afternoon?_____
g. What is the patient's discharge status?_____

Answer 1

a.011X (inpatient)
b.different
c.January
d.she chose the date (3, elective admission)
e.transfer from a different hospital (4)
f.afternoon
g.discharged and transferred to hospice-home (50)

Question 2

True or False: If code 4 (Transfer from a hospital, different facility) is used on an inpatient claim in FL 14 (Point of Origin for Admission or Visit), it indicates that the patient was admitted to the current facility after being transferred from a distinct inpatient unit in the same hospital.____

Answer 2

False

Question 3

Define the following terms and specify which form locator each occupies on the UB-04.
a.admission date_______________________________________________
______________________________________________________________
b.point of origin for admission or visit________________________________
_______________________________________________________________
c.patient discharge status__________________________________________
_______________________________________________________________

Answer 3

a. admission date :  The date the patient was admitted to the health care facility for inpatient care, outpatient service, or start of care.   FL 12
b. point of origin for admission or visit : The place or point of origin for emergency, elective, and other type of inpatient admission, or for outpatient services. The point of origin can be a non-health care facility such as home, work, or a physician's office; a transfer from another facility or the emergency department; or under the direction of a court of law; in the case of a newborn, the point of origin is inside or outside the billing hospital. It is indicated by a single-digit code.  FL 15
c. patient discharge status : An indicator of the patient's disposition or status as of the through date of the billing period. Categories for patient discharge status include routine discharge, discharged to another facility, still a patient, or expired. The patient discharge status code is a two-digit code.   FL 17

Question 4

True or False: Completion of FL 14 (Type of Admission or Visit) is required for Medicare billing for inpatient claims only. It is not necessary for outpatient claims.______

Question 5

Rewrite the following names in the format required for patient names on the UB-04.
a.Melanie Guidry
b.Paddy S. Trehorn III
c.Cheryl-Sue MacAllister
d.Gerald R. Brown, Esquire
e. Dr. Margaret b.Di Paola
f. Kara Von Essen
g. Juan Clemente, Sr.h. Mei W. Sing-Chang
i Sara T. O'Bryan

Question 6

Use the required hour codes to report the following admission times as they would be reported on a UB-04.
a.midnight____
b.3:59 a.m._____
c.1:12 p. m.______
d.11:00 a.m._____
e. noon______
f. 5:00 p. m.____
g. 9:22 a.m.h. 11:00 p.m.

Question 7

Which of the following are valid admission types for FL 14 on the UB-04?

A)urgent
B)emergency
C)baby born in hospital
D)newborn
E) nonemergency self-referral

Question 8

Indicate the correct code for FL 15 (Point of Origin for Admission or Visit) in each of the following situations.
a.A patient is admitted to the current facility as an inpatient and is being transferred from an ICF at which she was a resident.______
b.A patient with severe burns is admitted directly from the ER to the burn unit of the same hospital.________
c.A baby was born in the emergency department of the billing hospital.____
d.A battered woman and child are brought to the hospital by two police officers._____
e. A patient is admitted to the facility as a transfer from hospice but is still under a hospice plan of care._____
f. A patient is admitted to the psychiatric distinct part unit of a hospital after having been discharged from the acute short-term care unit of the same hospital, resulting in a separate claim.____
g. A physician at a freestanding clinic refers a patient to the current facility for a series of outpatient diagnostic services.____

Question 9

Indicate the correct code for FL 17 (Patient Discharge Status) in each of the following situations.
a.A patient is admitted on November 5 but leaves the hospital on November 8 against the medical advice of his doctor.___________
b.A TRICARE patient is admitted to a hospital-based hospice on September 2 and passes away on September 5.___________
c.A patient in an acute care hospital is discharged to a psychiatric distinct part unit of the hospital.__________
d.A patient is transferred back to the Veteran's Administration hospital in which he lives.__________
e. A patient undergoes same-day surgery and returns home at 4:00 p. m.__________
f. A patient is admitted to the hospital on August 5 and passes away on August 7.g. A patient is admitted to the hospital on May 5 and remains a patient until June 17. May is being billed
h. A patient is discharged from acute care in a private hospital to a designated cancer center.