Deck 4: UB-04 Overview CMS-1450

Question 1

There are a total of 67 form locators located on the UB-04.

Answer 1

False

Question 2

Revenue codes are facility specific.

Answer 2

False

Question 3

Revenue Code 0450 designates services performed in the Emergency Department.

Answer 3

True

Question 4

Professional services may not be billed on the UB-04 (CMS-1450).

Question 5

Only one payer may be listed on the UB-04 (CMS-1450).

Question 6

When a claim is an interim claim, meaning additional services/service dates for the encounter will follow on another claim, this is indicated by the use of a revenue code.

Question 7

When a claim submitted is employment related, it is designated as a condition code.

Question 8

The responsible party indicated in form locator (FL) 38 should always be the patient.

Question 9

In the case of a 29-year-old college student requesting services, the responsible party should be the parents.

Question 10

A revenue code in the 013X-015X categories would be appropriate for an outpatient hospital claim.

Question 11

A dirty claim refers to a claim that:

A) has errors or omissions.
B) has stray marks or spills.
C) does not tell the truth.
D) does not report the services as performed.

Question 12

The claim form that is universally accepted to submit charges performed by the facility is known as:

A) CMS-1500.
B) UB-04 (CMS-1450).
C)Advance Beneficiary Notice (ABN).
D) Electronic media claims (EMC).

Question 13

Data elements contained on the UB-04 claim are referred to as:

A) form locators.
B) boxes.
C) ID numbers.
D) field locators.

Question 14

An admission time of 7:58 a.m. would be recorded on the UB-04 claim form in FL 13 as:

A) 0758.
B) 07.
C) 758AM.
D) 0700.

Question 15

A bill type of 131 would indicate the services were provided as:

A) inpatient.
B) outpatient.
C) unknown.
D) ambulatory surgery center.

Question 16

Condition codes utilize what FL numbers?

A) 14/15
B) 18-28
C) 18
D) 31

Question 17

Condition codes are utilized for:

A) diagnosis.
B) cause of injury.
C) special circumstances, events, or conditions that surround the services.
D) procedures.

Question 18

FL 38 would identify the:

A) patient.
B) responsible party.
C) insurance carrier.
D) facility.

Question 19

Revenue codes should be placed in what order?

A) Alphabetic
B) Numeric, ascending
C) Numeric, descending
D) Order is not relevant

Question 20

FL 67 should list:

A) the principal diagnosis for inpatient.
B) the admitting diagnosis.
C) the patient's chief complaint.
D) any appropriate ICD-9-CM dx code.

Question 21

When a 19-year-old male arrives for services indicating that his mother should be billed for the services, his mother should be listed as the guarantor/responsible party.

Question 22

The providing physician information is located on FL 76-79.

Question 23

The type of bill for an outpatient hospital claim, admit through discharge would be _____.

Question 24

The type of bill for an inpatient hospital claim, admitted and discharged on the same claim would be ________.

Question 25

The admit time of 0259 be recorded in FL 13 as _______.

Question 26

The appropriate occurrence code for an auto accident-related claim (FL 31) would be _____.

Question 27

The revenue code categories utilized for professional services would be Revenue Code Categories 094X-098X.

Question 28

The revenue code series utilized for Inpatient Renal Dialysis is _____.

Question 29

Indicate the appropriate Type of Service that should be entered in FL 4 for Inpatient Swing Bed, First Claim.

Question 30

Determine the appropriate type of bill for an Inpatient Hospital claim for Late charges only.

Question 31

What would be the appropriate source of admission (FL 15) for a patient transferred from a skilled nursing facility?

Question 32

Assign the appropriate condition code (FL 18) for a patient who is homeless and does not have a permanent address.

Question 33

An occurrence code (FL 31) of 10 would indicate what condition?

Question 34

If insurance benefits are exhausted for the patient listed on the UB-04, what occurrence code would be appropriate?

Question 35

The deductible for a primary insurance would be entered in what form locator field and in what format?

Question 36

Assign appropriate Revenue Codes for the following:

MED-SUR-GY/PVT
DRUGS/NONGENERIC DRUGS
IV THER/PHARM/SVC
LAB/HEMATOLOGY
CT SCAN/HEAD

Question 37

Assign appropriate Revenue Codes for the following:

HOLTER MONT (Holter Monitor)
EEG
EMG
PAP SMEAR

Question 38

If a patient has both Medicare and Medicaid coverage, then Medicare would be the primary insurance and Medicaid would be the secondary insurance.?

Question 39

Indicate in what FL each of the following items should be entered:

Principal Diagnosis
Patient Reason for Visit
External Cause of Injury
Principal Procedure

Question 40

Who would be the responsible party in the following circumstances:
A 7-year-old child admitted for pneumonia is accompanied by her mother. She currently lives with her mother; however, she has insurance coverage through her father.

Question 41

The codes that must be listed on an outpatient claim that are not needed on an inpatient claim are CPT/HCPCS codes.

Question 42

The total number of payers that may be listed on the UB-04 are:

A) 2
B) 3
C) 4
D) 5