Resources: Appendix A, Appendix C, and Table 8.3 on pp. 258-259 of Medical Insurance
Refer to Table 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
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 formatted according to APA standards to be graded.
Post a 250 to 300 word response in which you explain, in your own words, how HIPAA, ICD, CPT, and HCPCS influence each of the ten steps of the medical billing process.
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.
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.
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.
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.
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?
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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Part One:
Resources: Appendix A, Appendix C, and Table 8.3 on pp. 258-259 of Medical Insurance
Refer to Table 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 formatted according to APA standards to be graded.
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robert bt8, 2014HCR 220No Comments
HCR 220 Week 9 Capstone CheckPoint
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Post a 250 to 300 word response in which you explain, in your own words, how HIPAA, ICD, CPT, and HCPCS influence each of the ten steps of the medical billing process.
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HCR 220 Week 8 DQ 2
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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 DQ 1
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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.
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HCR 220 Week 7 Individual 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.
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robert bt8, 2014HCR 220No Comments
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.medicalnewstoday.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 6 DQ 2
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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 DQ 1
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How are permanent codes different from temporary codes? What could be the result of a system without permanent codes? Provide examples in your answer.
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HCR 220 Week 6 CheckPoint Applying Level II HCPCS 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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