Category Archives: HCR 220

HCR 220 Week 9 Final Project How HIPAA Violations Affect the Medical Billing Process

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Part One: 

 

Resources:Appendix A, Appendix C, and Table 8.3 on pp. 258–259 of Medical Insurance

 

Refer toTable 8.3 on pp. 258–259 of your text to complete the CMS-1500 form, located in Appendix C, according to the following case study: 

 

A 67-year-old Medicare patient presents to the office, exhibiting symptoms of HIV infection. After detailed examination, symptoms are determined to be advanced AIDS with manifestation of Kaposi’s sarcoma and other opportunistic infections. 

 

Name: James Brown

Account Number: 080811

Insurer: Medicare

Policy Number: 1098765

ID number: 12345678910

DOB: 02/01/1940

Gender: Male

Insured: James Brown

Address: 1600 Pennsylvania Ave.

Wash. D.C. 60000

Marital Status: Widowed

Patient’s Employer: Retired

Nature of Condition: HIV, AIDS, Kaposi’s sarcoma

Date of Illness: 06/01/2007

Referring Physician: Thomas Glassman, M.D.

Physician ID: 1080808080

Federal Tax ID: 5551116679

Dates of Service: 06/01/2007, 06/15/2007, 07/07/2007, 08/01/2007

Procedure: Detailed examination, screening blood panel, pathology services

Patient Signature

 

Include ICD (categories only), CPT, HCPCS, and insurance information.

If you believe there is insufficient information provided to fill a required field with data, indicate this by typing N/A.

 

Post the completed CMS-1500 form as an attachment.

 

 

Final Project: How HIPAA Violations Affect the Medical Billing Process

 

Part Two: 

 

Write a 1,500 to 1,750 word essay in which you discuss implications of both forms of the patient’s diseases, HIV and AIDS, from the perspective of HIPAA confidentiality. Include the following in your essay:

 

Discuss why HIV and AIDS information is more sensitive than other types of health conditions.

Examine the social, legal, and ethical ramifications of improper information disclosure. 

Provide a minimum of three references from the University Library or the Internet. 

Your paper must be formattedaccording to APA standards to be graded.

Attach in a Word Document.

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HCR 220 Week 8 DQ 1 And DQ 2

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Week 8 DQ 1

How are the data elements contained in the HIPAA 837 claim form similar to the CMS-1500, and how does each form relate to the claims process? In your opinion, do the similarities between HIPAA 837 and CMS-1500 complicate or simplify the claims process? Explain your answers

Week 8 DQ 2

Why is it important to prepare a clean claim? What suggestions might you make to ensure that submission of a clean claim takes place? Provide examples. 

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HCR 220 Week 8 Checkpoint Complete a CMS-1500 Claim Form

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Checkpoint: Complete a CMS-1500 Claim Form

Complete the CMS-1500 claim form worksheet located in Appendix C. If you believe information provided in the following list is insufficient to adequately fill a required field with data, for example, to supply a specific diagnosis code, indicate this by typing N/A.
Name: Jane Smith
Insurer: TRICARE
Policy Number: 123456
ID number: 999000666
DOB: 01/01/1950
Gender: Female
Insured: James Smith, spouse
Address: 1111 Noname Court, Nowhere, NY 22222
Marital Status: Married
Patient’s Employer: Homemaker
Spouse’s Employer: U.S. Army
Nature of Condition: Routine exam
Patient Signature

 

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HCR 220 Week 7 CheckPoint Errors and Compliance in Coding

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Resource: pp. 207 & 211 of Medical Insurance, and Medical News Today Web site athttp://www.medicalrecentstoday.com/
Review the NPR Web site athttp://www.npr.org/templates/story/story.php?storyId=5348863
Write a 250 to 300 word response to the following: Briefly explain causes and solutions for three of the most common billing and coding errors. What effect does the Medicare National Correct Coding Initiative have on the billing and coding process? Explain your answers.

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HCR 220 Week 7 Assignment Evaluating Compliance Strategies

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Write a 750 to 1,050 word essay evaluating billing and coding compliance strategies. In your essay, provide an overview of the compliance process, and offer your judgment either supporting or criticizing a particular method. Make suggestions for improvement at the end of your evaluation.

Address the following questions in your essay:

What is the importance of correctly linking procedures and diagnoses?
What are the implications of incorrect medical coding?
How are medical coding, physician, and payer fees related to the compliance process?

Provide a minimum of one reliable reference from the University Library or the Internet.
Your paper must be formattedaccording to APA standards to be graded.
Attach in a Word Document.

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HCR 220 Week 6 DQ 1 And DQ 2

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Week 6 DQ 1

How are permanent codes different from temporary codes? What could be the result of a system without permanent codes? Provide examples in your answer. 

Week 6 DQ 2

Briefly explain the steps used to assign HCPCS codes for billing purposes. Do you believe it is more or less efficient to use different billing procedures for Medicare, Medicaid, or private payers? Why or why not? What are advantages and disadvantages of having unique coding systems for each type of insurance? 

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HCR 220 Week 6 CheckPoint Applying Level II HCPCS Modifiers

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Resource: Table 6.2 on p. 195 of Medical Insurance
Apply the appropriate Level II HCPCS code modifier for each of the following examples. Explain your rationale for each selection. For example, the first one would be:
Portable home oxygen unit – QM
Emergency ambulance transport and extended life support
Diagnostic mammogram, left breast
Cortisone 10 mg injection, right shoulder
Nonelectric wheelchair
Intravenous catheter line, right arm
Laboratory certification, cytology specimens
Chest X-ray
Prosthetic hip replacement, left side
Electric hospital bed

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HCR 220 Week 5 Exercise Working with CPT Modifiers

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Resource: Table 5.2 on p. 154 of Medical Insurance
Complete the exercise by identifying the correct CPT modifier to its corresponding procedure for the following:
Bilateral procedures
Multiple procedures
Prolonged evaluation and management
Unusual anesthesia
Mandated services

 

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HCR 220 Week 5 CheckPoint Describing CPT Coding Categories

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Resource: p. 145 of Medical Insurance
Write a 250 to 300 word response in which you assume you are a medical office manager who wants to make the coding process easier for employees to understand. To facilitate better understanding of this process, respond to the following:
Come up with buzzwords or slogans that would best describe the three CPT code categories.
What types of procedures or services are included in each of the three CPT code categories?
Provide one example for each category in your description.

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