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CHAPTER 12

HOSPITAL BILLING/UB-04

QuestionAnswer
1. HOW MANY DIAGNOSIS CAN BE LISTED ON THE UB-04 CLAIM FORM? 10
2. WHAT IS LISTED ON A CHARGE DESCRIPTION MASTER? Procedure code, procedure or service description.
3. WHAT ARE REVENUE CODES? Codes used to identify the department or unit that rendered services.
4. WHAT IS AN AMBULATORY SURGICAL UNIT? A department in a hospital that performs outpatient services for patients.
5. DEFINE COST OUTLIER A case that cannot be assigned an appropriate DRG (Diagnosis Related Group) because of an atypical situation.
6. WHAT IS THE SOFTWARE PROGRAM THAT ALLOWS A FACILITY TO CALCULATE ITS DIAGNOSIS RELATED GROUP (DRG) PAYMENT GROUP? Grouper
7. WHO MAINTAINS THE AMBULATORY PAYMENT CLASSIFICATION (APC) LIST? Centers of Medicare and Medicaid Services (CMS)
8. AMBULATORY PAYMENT CLASSIFICATION (APC) SYSTEM BASE PAYMENT ON Procedures
9. WHAT IS PROSPECTIVE PAYMENT SYSTEM? Established payment rates to hospitals prospectively, which means before services are rendered.
10. HOW OFTEN IS A PATIENT CONTROL NUMBER (PCP) ASSIGNED TO A PATIENT IN THE HOSPITAL? Is provided at each hospital admission.
11. DEFINE COMORBIDITY A preexisting condition that, because of its effect on the specific principal diagnosis, will require intensive therapy or cause an increase in length of stay by at least 1 day in approximately 75% of the cases.
12. WHAT ARE THE TYPES OF FACILITIES THAT WOULD USE UB-04 CLAIM FORMS? Hospitals, institutional facilities, inpatient care, hospice and skilled nursing.
13. MAJORITY OF HOSPITAL REIMBURSEMENT COMES FROM Insurance Companies
14. WHEN WILL A HOSPITAL BILL FOR PATIENT SERVICES? After patient has been discharged.
15. WHAT IS THE METHOD OF REIMBURSEMENT THAT PAYS HOSPITALS A FIXED RATE PER DAY FOR ALL SERVICES? Per diem
16. WHAT DOES OPPS STAND FOR? Outpatient Prospective Payment System
17. DIAGNOSIS RELATED GROUP (DRG) SYSTEM IS A TYPE OF Prospective Payment System
18, WHAT PHYSICIAN IS PRIMARILY RESPONSIBLE FOR PATIENT'S CARE WHILE IN THE HOSPITAL? Attending Physician
19. REFERRING TO DIAGNOSIS RELATED GROUP (DRG), WHAT DOES CC USES TO INDICATE? Complications or comorbidities.
20. IF THE TIME THAT THE PATIENT WAS ADMITTED TO THE HOSPITAL IS UNKNOWN, WHICH CODE WOULD BE USED (ON FORM LOCATOR 13)? 99
Created by: Lizbeth Romo
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