Question 1

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

Accepted Answer

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

Question 2

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

Accepted Answer

5 - Transfer from SNF

Question 3

FL 67 should list:

Accepted Answer

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

Question 4

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

Accepted Answer

A) True 
 B)False

Question 5

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

Accepted Answer

A) True 
 B)False

Question 6

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

Accepted Answer

A) True 
 B)False

Question 7

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

Accepted Answer

A) True 
 B)False

Question 8

Condition codes are utilized for:

Accepted Answer

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

Question 9

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

Accepted Answer

The answer of If insurance benefits are exhausted for the...

Question 10

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.

Accepted Answer

A) True 
 B)False

Question 11

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

Accepted Answer

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

Question 12

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

Accepted Answer

A) True 
 B)False

Question 13

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

Accepted Answer

The answer of The revenue code series utilized for Inpatient...

Question 14

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

Accepted Answer

The answer of The appropriate occurrence code for an auto...

Question 15

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

Accepted Answer

A) True 
 B)False

Question 16

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

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

Accepted Answer

The answer of Indicate in what FL each of the...

Question 17

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

Accepted Answer

The answer of The type of bill for an outpatient...

Question 18

Revenue codes are facility specific.

Accepted Answer

A) True 
 B)False

Question 19

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

Accepted Answer

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

Question 20

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

Accepted Answer

The answer of An occurrence code (FL 31) of 10...

Exam 4: UB-04 Overview CMS-1450

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

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

FL 67 should list:

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

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

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

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

Condition codes are utilized for:

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

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.

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

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

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

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

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

Indicate in what FL each of the following items should be entered: Principal Diagnosis Patient Reason for Visit External Cause of Injury Principal Procedure

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

Revenue codes are facility specific.

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

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