Medicare's Outpatient Prospective Payment System: Outpatient Billing and the UB-04

Course Code: REL-RCC-OPPS-C05

Hours: 0.5

Type: Online Course

Content Expiration Date: 12/31/2026

Learning Objectives:
Recall key elements of the UB-04.
Define the purpose of the UB-04.
Identify form locators and describe their purpose on the UB-04.

Outline:

Section 1: Introduction

About This Course

Learning Objectives

Development of the Uniform Bill

Electronic Version

Review

Section 2: Elements

Form Locator

Chapter 25: Claims Processing Manual

National Provider Identifier and Patient Demographics

Review

Section 3: Codes

Form Locator 4: Type of Bill

Condition Codes

Diagnosis Codes

Principal Diagnosis

Secondary Diagnosis

Review

Occurrence Codes and Dates

Value Codes

Revenue Codes

Reporting HCPCS Codes, Dates of Service, and Units

Review

Section 4: Conclusion

Course Summary

Course Contributors

References

Exam and BrainSparks

Glossary

Reviewer: Jean C. Russell, MS, RHIT

Jean Russell has over thirty years of healthcare and information system experience. Her areas of expertise include the Medicare outpatient prospective payment systems (APCs, and APGs), as well as ICD-10-CM/PCS training, Charge Description Master (CDM), admission status reviews, and outpatient coding and compliance. She is a frequent speaker at the national, state and local levels for HFMA and AHIMA professional groups. Jean has her Masters from the University of Houston in Biomedical Engineering; her Bachelors from Colgate University in Biology; and her RHIT from the independent study program through the American Health Information Management Association.

Target Audience:
The target audience for this course is: Healthcare Billing and Coding; in the following settings: Hospitals: Acute.

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Course Delivery Method and Format
Asynchronous Distance Learning with interactivity which includes quizzes with questions/answers, and posttests.