Additional payment may be obtained for inpatient cases that require more resources to treat a patient's condition. These situations are called _____ _____.
Answer: MS-DRG outliers
Final Revenue Cycle
- Which fields on the CMS-1450 (UB-04) are used to record charge information including revenue code, standard description, HCPCS, Unit, charge, and noncovered charge?
- In accordance with Health Insurance Portability and Accountability Act (HIPAA) regulations, standard formats for electronic transactions have been adopted. The adopted standard formats were developed by the American National Standards Institute (ANSI). The standard transaction format for the CMS-1450 (UB-04) is:
- Blocks 24A to 24J on which claim form are used to record charge information regarding the date of service, type of service, place of service, procedure code, days or units, and charges?
- Patient diagnosis information is reported in which of the following sections on the CMS-1500 claim form?
- What is the form completed by providers for the purpose of submitting charges for medical services and supplies to various third-party payers such as insurance companies and government programs?
- What term is used to describe each data field on the CMS-1450 (UB-04)?
- What is the coding system currently used to report significant procedures performed on an inpatient claim?
- Claim forms are used by providers to submit charges to payers for what purpose?
- What is the process by which a claim form is scanned and data on the claim are transferred into a computer system?
- What type of procedure code is recorded in FL 74 a-e on a claim for date of service after October 1, 2015?
- Health Care Common Procedure Coding System (HCPCS) Level I and II codes describing hospital outpatient services are reported on the CMS-1450 (UB-04) in what form locator (FL)?
- The CMS-1450 (UB-04) is a summary of the hospital visit and charges incurred. Where is information required to complete the claim form pulled from?
- List the acronyms for two organizations that developed the CMS-1500.
- An insurance claim form is completed by providers for the purpose of submitting charges for medical services and supplies to:
- How are FLs that are not designated for use by the NUBC labeled?
- Examples of significant procedures include:
- What is the insurance company called that is responsible to pay the claim after the primary and secondary payers have issued a payment determination?
- The hour the patient was admitted for inpatient care is recorded in which FL on the CMS-1450 (UB-04)?
- The definitions included in the Uniform Hospital Discharge Data Set (UHDDS) can be used to determine which codes should be reported. Item 12 of UHDDS states that all significant procedures are to be reported and defines a significant procedure as one that:
- Disadvantages of which claim submission method are that claims can be lost and there is no tracking?
- Two methods of claim form submission are manual and electronic transmission. Electronic transmissions are transmitted through:
- The difference between CMS-1500 and CMS-1450 (UB-04) is that CMS-1500 is used to submit charges for physician and outpatient services. How many fields does this form contain and what is the field called?
- Treatment authorization codes obtained from primary and secondary insurance companies are recorded in what fields on the CMS-1450 (UB-04)?
- Which section of the CMS-1450 (UB-04) is used to provide information about charges submitted on the claim form?
- Most claim forms are computer generated and submitted electronically in accordance with payer requirements and provisions of what legislation?