Deck 6: Overview of the Ub-04 Claim Form

Question 1

Which of the following items is not updated on a regular basis each year?

A)Medicare Inpatient Prospective Payment System (PPS)
B)ICD-9-CM and HCPCS
C)outpatient fee schedules
D)UB-04 form locators

Answer 1

D

Question 2

True or False: The guidelines and coding tips presented in Part 2 of this text apply mainly to Medicare inpatient and outpatient hospital claims._______

Answer 2

True

Question 3

Define the following terms.
a.form locator______________________________________________________________
b.UB-04__________________________________________________________________
c.EDI__________________________________________________________________

Answer 3

a. form locator : A numeric indicator that directs the reader to a specific box on a data collection form; there are eighty-one form locators on the UB-04.
b. UB-04 : The Uniform Bill introduced in 2004 by the National Uniform Billing Committee (NUBC) for submitting Medicare Part A inpatient and outpatient claims to Medicare fiscal intermediaries; used by most other payers as well because it meets the billing requirements of many types of provider facilities. The UB-04 officially replaced its predecessor, the UB-92, on March 1, 2007.
c. EDI : EDI stands for "electronic data interchange," a method of transmitting business information, such as the data in a health care claim, from one computer to another using publicly available standards, rather than transmitting the data on paper.

Question 4

Which of the following groups is responsible for deciding what data elements to include on the UB-04 claim form?

A)CMS
B)AHA
C)NUBC
D)ASC X12N Task Group on Health

Question 5

True or False: The UB-04 can be used for preparing Medicare and Medicaid claims but not TRICARE claims.____

Question 6

What is the difference between the CMS-1500 and the CMS-1450?___________________
What is the name of the electronic HIPAA equivalent for each?_____________________

Question 7

How many form locators are there on the UB-04?________________ How many of them are unlabeled?_____________Explain the use of the unlabeled form locators that are not intended for provider use. ___________________________________________________________________________

Question 8

A data entry of "A3 050611" in FL 31 (Occurrence Code and Date) is an example of what type of format?

A)alphanumeric
B)text-based
C)numeric
D)alphabetic

Question 9

True or False: The difference between paper claims and electronic claims is that paper claims are not created on a computer.______

Question 10

Match the term on the left with its description on the right.________clean claim? a.May be corrected and resubmitted by the provider________claim rejection?
B)Must be paid by the thirtieth day after the date of receipt________claim denial?
C)Can be appealed by the provider

Question 11

List three reasons a claim may be returned to the provider without being paid._______________________________________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________