Question

Provide 3-4 detailed sentences on each the questions below.

6) What are the three basic reimbursement methods for inpatient hospital services?

7) Why is comorbidity important in coding?

8) What information is included in a charge description master (CDM)?

9) What are the four sections of the UB-04 claim form?

10) What types of institutional facilities use the UB-04 claim form?

Answer 1

6) What are the three basic reimbursement methods for inpatient hospital services?

1. Discount from Billed Charges
2. Fee-for-Service
3. Value-Based Reimbursement
4. Bundled Payments
5. Shared Savings

7) Why is comorbidity important in coding?

For the purposes of coding diagnoses on claims, a complication is a condition that arises during the hospital stay that prolongs the length of stay. A comorbidity is a pre-existing condition that affects the treatment received and/or prolongs the length of stay.

The chart below shows potential complications and comorbidities associated with a cesarean section and a transurethral prostatectomy.

Examples of potential complications and comorbidities

Procedure	Complications	Comorbidities
Cesarean section	Hemorrhage Infection	Diabetes Ventricular tachycardia Chronic asthma
Transurethral prostatectomy	Hemorrhage Infection Renal complications	Diabetes Arteriosclerotic heart disease Emphysema

Implications on DRG

In some cases, DRG payment may change due to patient complications and comorbidities. Complications and comorbidities should be documented in the patient record and listed on the discharge face sheet.

8) What information is included in a charge description master (CDM)?

The Charge Description Master (CDM), sometimes called the Chargemaster or Procedure Code Dictionary, is the database of all billable items that go on patients’ accounts. It contains all the descriptions, revenue codes, department associations, alternate CPT/HCPCS codes for different payer.

9) What are the four sections of the UB-04 claim form?

There are 81 fields or lines on a UB-04. They're referred to as form locators or "FL." Each form locator has a unique purpose, but the important four sections of the UB-04 claim form are as below:

• Form locator 1: Billing provider name, street address, city, state, zip, telephone, fax, and country code
• Form locator 2: Billing provider's pay-to name, address, city, state, zip, and ID if it's different from field 1
• Form locator 3: Patient control number and the medical record number for your facility
• Form locator 4: Type of bill (TOB). This is a four-digit code beginning with zero, according to the National Uniform Billing Committee guidelines.

10) What types of institutional facilities use the UB-04 claim form?

The UB-04 uniform billing form is the standard claim form that any institutional provider can use for the billing of medical and mental health claims. It's printed with red ink on white standard paper. Although developed by the Centers for Medicare and Medicaid (CMS), the form has become the standard form used by all insurance carriers.

The UB-04 (CMS 1450) is a claim form used by hospitals, nursing facilities, in-patient, and other facility providers