Certified Revenue Cycle Representative (CRCR) Practice Exam

Which claim forms are currently used by the healthcare industry to submit claims to third-party payers?

1. CMS 1500 and HCFA 1500

2. UB-04 and CMS 1500

3. UB-92 and HCFA 1500

4. UB-04 and UB-92

The correct answer is: UB-04 and CMS 1500

The correct answer is that the UB-04 and CMS 1500 forms are currently used in the healthcare industry for submitting claims to third-party payers. The CMS 1500 form is primarily used for outpatient services, and it is designed for claims related to physician services, as well as other healthcare providers who are not hospital-based. This form captures detailed information about the patient, care received, procedures performed, and associated costs. On the other hand, the UB-04 form is utilized for inpatient services and claims submitted by institutional providers, such as hospitals. This form allows institutions to itemize the services provided during a patient's stay, including room and board, nursing care, and various treatments and procedures. The combination of these two forms allows for comprehensive coverage of both outpatient and inpatient claims in the healthcare billing process. It is essential for providers to understand which form to use based on the type of service being billed, as correct submission ensures prompt payment from payers. The other answer choices refer to forms that are outdated or not currently standardized in practice. The UB-92 was an older institutional claim form that has largely been replaced by the UB-04, and while the HCFA 1500 was commonly referred to in the past, it has been