Question 1

Which committee maintains the UB-04?

Accepted Answer

The UB-04 is maintained by the National Uniform Billing Committee.

Question 2

Which claim form is also known as the hospital paper claim form?

Accepted Answer

In some situations, a paper claim form called the UB-04 (uniform billing 2004), also known as the CMS-1450, is also accepted for hospital billing.

Question 3

A machine operator had an accident and cut off two of his fingers. What is this an example of?

Accepted Answer

Emergency care involves a situation in which a delay in the treatment of the patient would lead to a significant increase in the threat to life or a body part.

Question 4

What is QIO the abbreviation for?

Accepted Answer

When DRGs were established, Medicare also set up Peer Review Organizations (PROs), which were later renamed Quality Improvement Organizations (QIOs).

Question 5

What is PRO the abbreviation for?

Accepted Answer

When DRGs were established, Medicare also set up Peer Review Organizations (PROs), which were later renamed Quality Improvement Organizations (QIOs).

Question 6

Which of the following is urgently needed care (not emergency care)?

Accepted Answer

Emergency care differs from urgently needed care, in which the condition must be treated right away but is not life-threatening.

Question 7

Why are electronic claims beneficial for billing purposes?

Accepted Answer

The turnaround time for electronic claims is usually from ten to fifteen days faster than for manual paper claims, improving cash flow.

Question 8

Which form is sent to hospitals to advise that payment will be transmitted by payers to their accounts?

Accepted Answer

Hospitals receive a remittance advice (RA) when payments are transmitted by payers to their accounts.

Question 9

Which of the following does Medicare Part A not cover?

Accepted Answer

Medicare Part A, known as hospital insurance, helps pay for inpatient hospital care, skilled nursing facilities (SNF), hospice care, and home health care.

Question 10

What term is used to describe conditions that develop after surgery and/or treatments that affect care during the hospitalization?

Accepted Answer

Conditions that develop as complications of surgery or other treatments are coded as complications.

Question 11

What term is also used to describe coexisting conditions that affect care during the hospitalization?

Accepted Answer

Other conditions at admission that affect care during the hospitalization are called comorbidities, meaning coexisting conditions.

Question 12

A patient is rushed to the emergency for having symptoms of a heart attack, and upon further testing, it is discovered that he did have a heart attack in addition to terminal cancer and end stage renal disease. Which is considered the primary diagnosis?

Accepted Answer

The principal diagnosis is the condition established after study to be chiefly responsible for the admission.

Question 13

Which new system has Medicare adopted to better reflect the different severity of illness among patients who have the same basic diagnosis?

Accepted Answer

In 2008 Medicare adopted a new type of DRG called Medicare-Severity DRGs (MS-DRGs) to better reflect the different severity of illness among patients who have the same basic diagnosis.

Question 14

What method is used by many private payers for setting prospective payment for hospital services?

Accepted Answer

Many private payers have also adopted the DRG method of setting prospective payments for hospital services.

Question 15

What is the UB-04 also referred to as?

Accepted Answer

In some situations, a paper claim form called the UB-04 (uniform billing 2004), also known as the CMS-1450, is also accepted.

Question 16

What does the "P" in 837P stand for?

Accepted Answer

This electronic data interchange (EDI) format, similar to the 837 claim, is called I for Institutional; the physicians' claim is called 837P (Professional).

Question 17

What does the "I" in 837I stand for?

Accepted Answer