| Course | HCR 203 Medical Claims Processing and Compliance (HCR/203) |
|---|---|
| Week | 3 |
| Paper type | Facility claim exercise |
| Length | about 910 words, 3 double-spaced pages plus title page and references |
| Format | APA 7 student paper |
| School | University of Phoenix |
| Program | BS in Health Administration |
| Updated | September 2026 |
Free sample paper for HCR 203 Week 3
Type of Bill 0851 and Four Revenue Lines: Billing a Chest Pain Visit From a 25-Bed Critical Access Hospital's Emergency Department on the UB-04
[Student Name]
University of Phoenix
HCR/203: Medical Claims Processing and Compliance
Week 3 Assignment
[Instructor Name]
[Date]
The hospital, the patient and the charges are composites written for a model exercise; form instructions and payment rules come from the sources listed.
Why Hospitals Use a Different Claim
A hospital visit produces two kinds of bills. The physician bills for professional work on the professional claim. The hospital bills for its facility resources, the emergency department, nursing, equipment, laboratory, imaging and supplies, on the institutional claim, whose paper version is the UB-04, also called the CMS-1450. The code sets used in its fields, such as revenue codes and discharge status codes, are maintained by a national committee convened by the hospital industry (National Uniform Billing Committee, n.d.).
How Critical Access Hospitals Are Paid
Most hospitals are paid by Medicare through fixed prospective rates. Critical access hospitals, small rural hospitals limited to 25 beds, are paid differently: Medicare reimburses each one at slightly more than its cost, 101 percent, figured from the annual cost report (Medicare Payment Advisory Commission, 2024). Accurate charges still matter, because they feed the cost report and are billed to other payers.
The Visit
A 58-year-old man came to the hospital's emergency department at 9:40 p.m. with chest pressure. Nurses and the emergency physician evaluated him, performed an electrocardiogram, drew blood for troponin and obtained a two-view chest X-ray. All results were normal. He was diagnosed with other chest pain, likely musculoskeletal, and discharged home at 1:15 a.m. with instructions to follow up with his physician.
Form Locator 4: Type of Bill
The type of bill is 0851. After the leading zero, 8 and 5 identify a critical access hospital, and 1 means an admit-through-discharge claim, a single complete bill for this visit.
Form Locators 6, 12 to 17: Dates and Status
The statement covers period in locator 6 runs from the arrival date to the discharge date, since the visit crossed midnight. Locators 12 and 13 hold the admission or visit date and hour. Locator 14 shows the visit priority as emergency, locator 15 the point of origin as a non-health care facility, meaning he came from home, and locator 17 the discharge status as 01, discharged to home.
Form Locators 42 to 47: The Revenue Lines
Each line pairs a revenue code with a description, a procedure code, service date, units and charges. Line 1: revenue code 0450, emergency room, with 99284, the facility emergency visit level set by the hospital's criteria, one unit. Line 2: revenue code 0730, electrocardiogram, with 93005, the tracing without interpretation, since the physician bills the interpretation. Line 3: revenue code 0301, laboratory chemistry, with 84484, troponin, one unit. Line 4: revenue code 0324, chest X-ray, with 71046, two views. A final line with revenue code 0001 carries the total charges. The Medicare claims manual requires outpatient lines to carry procedure codes beside revenue codes and describes each locator (Centers for Medicare & Medicaid Services, 2023). The revenue code tells the payer which department did the work; the procedure code tells it exactly what the department did.
Form Locators 50 to 57: Payer and Provider
Locator 50 names Medicare as the payer, 56 carries the hospital's NPI and the hospital's Medicare certification number and tax identifier appear in the provider fields.
Form Locators 67 to 72: Diagnoses
Locator 67 holds the principal diagnosis, R07.89, other chest pain, and locator 70 the patient's reason for visit, the same symptom. His hypertension, documented and affecting care, is an other diagnosis in locators 67A onward, coded I10.
Who Bills the Physician's Work
The emergency physician's evaluation and the electrocardiogram and X-ray interpretations are billed separately on a professional claim by the physicians' group, using the same date and the professional components of the tests. Some critical access hospitals elect an optional method in which the hospital bills professional services on its own claim with special revenue codes; this hospital does not.
Comparing the Two Claims
The professional claim lists services with procedure codes and diagnosis pointers. The facility claim lists departments with revenue codes, adds the type of bill, admission and discharge fields and a reason for visit and totals charges on revenue code 0001. Both are sent electronically in standard formats, the professional and institutional versions of the claim transaction.
Charges and the Chargemaster
The hospital's charges come from its chargemaster, a master list that links each billable item to a revenue code, a procedure code where needed and a price. When the emergency department nurse documented the troponin test, the order triggered the laboratory line automatically. Errors in the chargemaster repeat on every claim, so the billing company reviews it with the hospital's finance staff twice a year. Last spring they found that a supply item had been linked to a retired procedure code, causing dozens of rejections before the link was corrected.
Checks Before Release
The billing company's specialists check that the type of bill matches the hospital and visit, the statement dates bracket all service dates, each outpatient revenue line has a procedure code, units match services, the discharge status is correct and the total equals the sum of the lines.
Conclusion
A single emergency visit at a critical access hospital produces a facility claim built around the type of bill, dates and status fields, revenue lines paired with procedure codes and diagnoses including a reason for visit, while the physicians bill their work separately. Understanding these differences, and the cost-based payment behind them, lets a claims specialist submit facility claims that are accepted the first time.
References
Centers for Medicare & Medicaid Services. (2023). Medicare claims processing manual: Chapter 25, completing and processing the Form CMS-1450 data set. https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/clm104c25.pdf
Medicare Payment Advisory Commission. (2024). Critical access hospitals payment system (Payment basics). https://www.medpac.gov/wp-content/uploads/2024/10/MedPAC_Payment_Basics_24_CAH_FINAL_SEC.pdf
National Uniform Billing Committee. (n.d.). National Uniform Billing Committee. American Hospital Association. https://www.nubc.org/
What the HCR 203 Week 3 instructions ask
HCR 203 Week 3 usually covers facility or institutional claims. Students may be asked to explain the UB-04, or CMS-1450, and its electronic equivalent, identify key form locators such as type of bill, statement dates, admission and discharge information, revenue codes, procedure codes, units, charges, diagnoses and provider identifiers, and compare facility claims with professional claims. Some versions include a scenario to complete. Strong answers explain the purpose of each form locator used, choose revenue codes that match the department, pair them with procedure codes where outpatient rules require, report correct units and patient status and explain how facility payment differs from physician payment.
How this HCR 203 Week 3 example is built
The exercise starts with the difference between the facility's claim, for the building, staff, equipment and supplies, and the physician's claim, for professional work. It explains critical access hospital payment at 101% of reasonable cost. The visit follows: a man with chest pain seen in the emergency department, given an electrocardiogram, a troponin test and a chest X-ray and discharged home. The claim is completed locator by locator: type of bill 0851, statement period, admission type and source, discharge status, four revenue lines with procedure codes, units and charges, the total line, diagnoses and the hospital's identifiers. A comparison with the CMS-1500 and a pre-release checklist close the exercise.
HCR 203 Week 3 grading rubric: where the points go
The facility claims week is generally graded on accurate use of the UB-04 and on understanding how it differs from the professional claim. Instructors check the type of bill, statement dates, admission and discharge fields, revenue codes matched to services, procedure codes where required, units and charges, diagnoses and identifiers. Points go to explaining why each locator matters and to describing how hospital payment works, including methods such as diagnosis-related groups, outpatient payment systems or cost-based payment. Citing official form instructions supports the answer, and a filled-in form or table of locators helps. Clear layout and APA references complete the grade. Answers that use physician procedure codes without revenue codes, or confuse facility and professional billing, usually lose points.
HCR 203 Week 3 help: mistakes to avoid
A common problem in HCR 203 Week 3 is treating the UB-04 like a professional claim with more boxes. Explain that it bills the facility's resources, organized by revenue codes that identify departments. Another is choosing the wrong type of bill; the four digits tell the payer the facility type, the kind of care and the bill's sequence. Students also forget that outpatient lines often need procedure codes beside revenue codes. Report the discharge status accurately. Remember the total line with revenue code 0001. Explain who bills the physician's work. Finally, check dates, units and totals before release, since facility claims often have many lines and one wrong date can reject the whole bill.
Related HCR 203 sample papers
Other HCR 203 week samples
- HCR 203 Week 1: The Claims Cycle and Specialist Role
- HCR 203 Week 2: Completing the CMS-1500 Claim
- HCR 203 Week 4: Denials, Rejections and Appeals
- HCR 203 Week 5: HIPAA and Claims Compliance
More BS in Health Administration sample papers
- HCR 201 Week 3: Procedure Coding With CPT
- HCR 202 Week 3: The Reimbursement Process
- HCS 120 Week 3: Who's in Health Administration
- HCS 131 Week 3: Collaboration Through Conflict
HCR 203 Week 3 questions, answered
What does HCR/203 Week 3 usually ask for?
Many sections ask students to explain facility claims on the UB-04 or its electronic version, including type of bill, revenue codes, procedure codes, units, diagnoses and how facility claims differ from professional claims.
Where can I find a free HCR 203 Week 3 sample paper?
The critical access hospital UB-04 exercise is shown here in full without charge, with margin notes on each form locator. Send your own scenario for a free first draft.
What is a type of bill on the UB-04?
A four-digit code in form locator 4 whose digits after the leading zero identify the type of facility, the type of care and the sequence of the bill in the episode of care.
What are revenue codes?
Four-digit codes in form locator 42 that identify the department or type of service, such as emergency room, laboratory or radiology, for each charge on a facility claim.
How are critical access hospitals paid by Medicare?
Medicare pays each critical access hospital 101% of its reasonable costs for inpatient and outpatient services, based on its cost reports, rather than fixed prospective rates.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official University of Phoenix document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
Request this one custom, free · All HCR 203 week samples · All courses