Solution Manual for Understanding Hospital Coding and Billing A Worktext 3rd Edition by Diamond

Solution Manual for Understanding Hospital Coding and Billing A Worktext 3rd Edition by Diamond

Chapter 4: UB-04 Overview
Learning Objectives
• Demonstrate an understanding of the UB-04/CMS-1450
• Discuss the requirements for Facility/Provider Information (FL 1–7)
• Review Patient Information Data Fields (FL 8–17)
• Describe the proper use of Condition Codes (FL 18–30)
• Demonstrate the appropriate use of Occurrence Codes (FL 31–37)
• Discuss requirements for Value Codes/Amounts (FL 38–41)
• Identify Revenue Codes and associated information (FL 42–49)
• Demonstrate an understanding of Third-Party Information (FL 50–65)
• Document requirements for Diagnosis/Procedure Code Information (FL 66–75)
• Describe the proper use of the Remarks Section (FL 76–81)
Key Terms
Birthday rule
Claims scrubber
Clean claim
Condition codes
Dirty claim
Electronic media claims (EMC)
Form locators (FL)
Form record
Lifetime reserve days
National Provider Identification (NPI) number
Occurrence codes
Revenue codes
UB-04
Working aged
PRACTICE EXERCISE 4-1
INSTRUCTOR’S NOTE:
Have the student refer to the figure on completing the UB-04 for completion of these
exercises. Complete the information for FL 4 (Type of Bill):
Digit 1 Digit 2 Digit 3 Digit 4
1. Outpatient Hospital, Admit Through Discharge 0 1 3 1
2. Inpatient Hospital, Admit Through Discharge 0 1 1 1
3. Outpatient Hospital, Physical Therapy, Second Month in
Continuing Claim
0 1 3 3
4. Inpatient Hospital, Admitted/Discharged Same Bill 0 1 1 1
5. Outpatient Hospital, Late Charges Only 0 1 3 5
6. Skilled Nursing Facility, Intermediate Care I, Admitted 2 Months 0 2 4 3
!
42 Chapter 4 UB-04 Overview
Current Procedural Terminology © 2014 American Medical Association. All Rights Reserved.
Ago, Remaining in SNF
7. Rural Health Clinic, 1 Day Services 0 8 1 1
8. Hospital ASC, 1 Day Services 0 8 3 1
9. Hospital Based Outpatient Rehabilitation, 30 Days (1 Mo) Only 0 6 5 1
10. Inpatient Hospital, Admitted 01-01-YY, Continuing Inpatient,
Billing for Month of 02-YY
0 1 1 3
Complete the information for FL 6:
1. Patient Admitted 01/03/20YY/Discharged 01/30/20YY
Insurance will cover entire admission period.
FL 6 010320YY 013120YY FL 7 028 FL 8 000
2. Patient Admitted 02/20/20YY/Still Inpatient/Billing for Month of February Only
Insurance will cover entire month of February.
FL 6 022020YY 022820YY FL 7 009 FL 8 000
3. Patient Receiving Occupational Therapy 01/31/YY only
Service authorized for 01/31/YY by insurance carrier.
FL 6 013120YY 013120YY FL 7 001 FL 8 0000
4. Patient Receiving Physical Therapy from 01/04/YY-01/08/YY
Received one treatment daily. Insurance authorized four treatments only.
FL 6 010420YY 010820YY FL 7 004 FL 8 000
5. Patient Admitted on 03/01/20YY/Discharged 03/17/20YY
First 10 Days will be authorized in full; however, subsequent days will have a $100.00 per day patient
responsibility.
FL 6 030120YY 031720YY FL 7 017 FL 8 000