Certified Revenue Cycle Representative (CRCR) Practice Exam

What is required for the UB-04/837-I to generate payment from Medicare?

1. Revenue codes

2. Correct Part A and B procedural codes

3. The CMS 1500 Part B attachment

4. Medical necessity documentation

The correct answer is: Revenue codes

The generation of payment from Medicare using the UB-04/837-I form requires the inclusion of revenue codes. Revenue codes are crucial because they identify specific services and types of care provided to patients. Each revenue code corresponds to different categories of service that allow Medicare to determine payment amounts accurately. They help in breaking down and categorizing the services into various components that match with Medicare’s payment rules. While other elements, such as procedural codes or documentation of medical necessity, play important roles in the overall billing and claims process, revenue codes are specifically formatted to interact with Medicare’s payment system by detailing the types of services and their associated costs. Without properly documented revenue codes on the UB-04, Medicare may not be able to process the claim correctly, leading to delays or denials in payment. Thus, including revenue codes is essential for ensuring that the services rendered are legitimate and that corresponding payment can be calculated and processed.