Chapter 26 — Quiz

26 questions. Answers and explanations are in the instructor guide.

1. The UB-04 is also known as the:

  • A. CMS-1500
  • B. CMS-1450
  • C. 837P
  • D. NUCC form

2. The UB-04's electronic equivalent is the:

  • A. 837P
  • B. 837I
  • C. 835
  • D. 270

3. The UB-04 is maintained by the:

  • A. NUCC
  • B. NUBC
  • C. AMA
  • D. OIG

4. The UB-04's fields are called:

  • A. Items
  • B. Boxes
  • C. Form locators
  • D. Segments

5. Read the type of bill 0131. The middle digits mean:

  • A. Skilled nursing, inpatient
  • B. Hospital, outpatient
  • C. Hospital, inpatient Part A
  • D. Clinic, outpatient

6. A frequency digit of 7 indicates:

  • A. An original claim
  • B. An interim continuing claim
  • C. A replacement of a prior claim
  • D. A void

7. A corrected claim submitted with frequency 1 produces:

  • A. A correction
  • B. A duplicate
  • C. A void
  • D. An appeal

8. A revenue code identifies:

  • A. What service was performed
  • B. The department or cost center that provided it
  • C. The diagnosis
  • D. The rendering physician

9. Revenue code 0450 is:

  • A. Pharmacy
  • B. Laboratory
  • C. Emergency room
  • D. Operating room

10. Revenue code 0636 is used for:

  • A. All pharmacy charges
  • B. Drugs requiring detailed coding, with a HCPCS code and units
  • C. Room and board
  • D. The total line

11. On an inpatient claim, HCPCS codes are:

  • A. Required on every line
  • B. Generally not required on most lines
  • C. Prohibited
  • D. Required only for surgery

12. The reason for that difference is:

  • A. The form
  • B. The payment system — the DRG derives from diagnoses and procedures, not charge lines
  • C. A NUBC rule
  • D. The number of form locators

13. Which family reports a date range?

  • A. Condition codes
  • B. Occurrence codes
  • C. Occurrence span codes
  • D. Value codes

14. "Four covered days" is reported by a:

  • A. Condition code
  • B. Occurrence code
  • C. Occurrence span code
  • D. Value code

15. Condition Code 44 reports:

  • A. A transfer
  • B. An inpatient admission changed to outpatient before discharge
  • C. A readmission
  • D. A qualifying stay

16. FL 17 reports:

  • A. The admitting diagnosis
  • B. Where the patient went at the end of the stay
  • C. The attending physician
  • D. The type of bill

17. Under the transfer rule, a hospital that transfers rather than discharges may be paid:

  • A. The full DRG plus an outlier
  • B. A per-diem amount rather than the full DRG
  • C. Nothing
  • D. The receiving facility's rate

18. A discharge status of 30, "still a patient," on a claim whose frequency digit is 1:

  • A. Is correct
  • B. Is a mismatch between two fields that must agree
  • C. Requires an occurrence span code
  • D. Triggers the transfer rule

19. FL 3a holds:

  • A. The medical record number
  • B. The patient control number, which the payer returns on the remittance
  • C. The NPI
  • D. The admission date

20. FL 67's principal diagnosis is the condition:

  • A. Suspected at admission
  • B. Chiefly responsible for the encounter, established after study
  • C. The patient reported
  • D. With the highest relative weight

21. FL 48 reports:

  • A. Total charges
  • B. Non-covered charges
  • C. Prior payments
  • D. Estimated amount due

22. FL 76 identifies the:

  • A. Billing provider
  • B. Operating provider
  • C. Attending provider
  • D. Referring provider

23. Under the three-day payment window, hospital outpatient services furnished within three days before an admission are:

  • A. Always billed separately
  • B. Bundled into the inpatient claim in defined circumstances
  • C. Denied
  • D. Billed to the patient

24. A facility argues that its separately billed outpatient claim was correct. This argument:

  • A. Defeats the recoupment
  • B. Is compatible with the rule — it was correct as a standalone claim and should not have been one
  • C. Requires an appeal
  • D. Applies only to diagnostic services

25. In §26.9's counterfactual, the professional allowed amount:

  • A. Rises, because the facility adds value
  • B. Falls, because the practice expense moved to the facility
  • C. Is unchanged
  • D. Becomes zero

26. In the same counterfactual, the patient's share:

  • A. Falls
  • B. Is unchanged
  • C. Nearly doubles
  • D. Is eliminated by the facility claim