Question 1
What are FL 35-36 Occurrence Span Codes & Dates used for?
Correct Answer:
Events that would affect the billing/payment with a to and from date
Explanation:
The main idea is that these fields capture events that can affect how a claim is paid, along with the time frame for those events. Occurrence span codes identify the type of event (for example, an accident, date of injury, onset of illness, or other qualifying incident), and the corresponding dates show when that event occurred, including the from-to period if it spans a range. Payers use this information to determine liability, coverage rules, and any special processing required for the claim. This helps explain why a claim might be paid differently or require additional documentation. These fields aren’t about patient demographics, diagnosis codes, or discharge status; they specifically provide the timing of events that can influence billing.
Question 2
HIPPS rate codes are used for payment determinations under several prospective payment systems. Which is an example of systems where HIPPS are used?
Correct Answer:
Skilled Nursing Facilities, Inpatient Rehabilitation Facilities, and Home Health Agencies
Explanation:
HIPPS codes are used to determine payment amounts under certain post-acute prospective payment systems. The correct example includes Skilled Nursing Facilities, Inpatient Rehabilitation Facilities, and Home Health Agencies because these settings all use HIPPS-based PPS to establish payment rates based on patient characteristics and resource use. General acute care hospitals are paid with DRGs, not HIPPS; outpatient clinics rely on outpatient prospective payment methods or APCs rather than HIPPS; and pharmacy benefit managers operate in drug benefits rather than PPS payment systems. So, the settings listed are the ones where HIPPS rate codes drive payment determinations.
Question 3
Which data element in the header identifies the facility submitting the claim?
Correct Answer:
Facility name and address
Explanation:
The data element that identifies the facility submitting the claim is the facility name and address. In the UB-04 header, this field records who is filing the claim—the exact hospital or clinic submitting the form—so that the payer and involved providers know the source of the claim. Other header elements serve different purposes: payer information shows who is responsible for payment, not who submits; occurrence codes capture dates of events like admission or discharge; and diagnosis pointers link diagnoses to procedures. So the facility name and address is the piece that directly identifies the submitting institution.
Question 4
What is the primary purpose of the Present on Admission (POA) field on the UB-04 form?
Correct Answer:
To indicate whether a diagnosis was present at hospital admission.
Explanation:
The main idea here is to capture whether a diagnosis was already present when the patient was admitted to the hospital. The POA field marks each diagnosis as existing at admission or not, so clinicians and coders can distinguish pre‑existing conditions from those that developed during the stay. This distinction matters for quality reporting and reimbursement, because hospital‑acquired conditions and certain metrics may be handled differently depending on whether the condition was present on admission. It’s not about the patient’s language, the date of service, or reporting the principal procedure.
Question 5
Which field holds the country code used when services occur outside the United States?
Correct Answer:
Country code field
Explanation:
When a claim includes services performed outside the United States, you need a field that specifically records the country where the service occurred. The country code field is the designated place on the UB-04 form to store that foreign country code, ensuring the claim is processed with the correct international billing rules and location context. The birthdate field is about the patient’s date of birth, not service location. The source of referral field shows who referred the patient, not where the service happened. The DHR field carries other administrative or clinical data unrelated to the country of service.
Question 1
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Prepare with the Completing the UB-04 Claim Form – Introduction Practice Test practice quiz. This question bank includes 10 questions covering field, claim, codes, hipps, and payment. Use it to review important concepts, identify knowledge gaps, and build confidence for the related exam, course, or assessment.

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Completing the UB-04 Claim Form – Introduction Practice Test

This practice set contains 10 questions from the matching question bank and focuses on field, claim, codes, hipps, and payment. Work through each question carefully, review the provided solutions, and revisit topics that need more study before your next attempt.

This is an independent study resource intended for practice and review; it is not an official examination or an endorsement by any organization named in the title.

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