UB-04/CMS 1500 Basics Assessment Quiz

What does the "B" in UB-04 stand for?

• Budgeting

• Banking

• Booking

• Billing

Another name of UB04 form is?

• W9 Form

• HCFA

• CMS1450

• CMS1500

The "Type of Bill" or Bill Type is found in field locator 4. Not including the leading zeros, what do the three digits represent?

• Facility Type, Type of care, Frequency

• Facility, Classification, Frequency

• Facility, bill, Frequency

• Facility, Type Bill Classification, Frequency

Rev codes are only used for IP hospital claims.

• True

• False

What is the number of the field locator where revenue codes are listed?

• 43

• 24

• 0272

• 42

What is the purpose of the occurrence codes? (Select all that apply)

• Medicare as secondary

• Identify conditions

• Significant events affecting claim processing

• Patient co-pay

In which FL we can find the Authorization number in UB04

• 56

• 64

• 71

• 63

In which Field Locator the DRG/PPS information displayed on a UB-04 form?

• 71

• 66

• 68

• 56

What does IP stand for in the context of a hospital claim?

• Insurance Policy

• Inpatient

• Internet Protocol

• Important

What is the purpose of occurrence codes in a UB-04 form?

• To increase costs

• To hide information

• To identify significant events affecting claim processing

• To confuse readers