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1

HCR 220 Week 9 Final Project How HIPAA Violations Affect the Medical Billing Process
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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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2

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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3

HCR 220 Week 8 DQ 1 And DQ 2
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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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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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5

HCR 220 Week 7 CheckPoint Errors and Compliance in Coding
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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.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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6

HCR 220 Week 7 Assignment Evaluating Compliance Strategies
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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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7

HCR 220 Week 6 DQ 1 And DQ 2
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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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8

HCR 220 Week 6 CheckPoint Applying Level II HCPCS Modifiers
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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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9

HCR 220 Week 5 Exercise Working with CPT Modifiers
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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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10

HCR 220 Week 5 CheckPoint Describing CPT Coding Categories
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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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11

HCR 220 Week 5 Assignment Assigning Evaluation and Management (E M) Codes
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HCR 220 Week 5 Assignment Assigning Evaluation and Management (E M) Codes
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Assignment: Assigning Evaluation and Management (E/M) Codes
Resources:Figure 5.3 on p. 161, and Table 5.4 on p. 165 of Medical Insurance
Assign appropriate E/M codes for the following five cases:
Initial consultation performed for a 43-year-old woman with unexplained weight loss, abdominal pain, and rectal bleeding. A comprehensive history and examination is performed.

A 32-year-old patient presents complaining of flu-like symptoms characterized by unremitting cough, sinus pain, and thick nasal discharge. An examination reveals bronchitis and sinus infection. The patient is prescribed a 7-day course of Zithromax.

Established patient on Lithium presents for routine blood work to monitor therapeutic levels and kidney function. A nurse reviews the results and advises the patient that tests are normal, and no change in dosage is indicated.

A 78-year-old diabetic female presents for check-up and dressing change of wound on left foot. An examination reveals the wound is healing. The nurse applied new dressing and patient will return for a check-up in one week.

A mother brings in her 4 ½ month-old baby for a routine wellness check. An examination reveals the child to be in good health and making adequate progress.
Provide the rationale you used to assign a particular E/M code in 2 to 3 complete sentences for each of the case studies.



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12

HCR 220 Week 4 DQ 1 And DQ 2
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HCR 220 Week 4 DQ 1 And DQ 2
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Week 4 DQ 1

Suppose you were helping a new office file clerk who was curious about the coding process. How would you explain appropriate use and purposes of the Alphabetic Index and Tabular List to the file clerk? What problems might occur if proper coding procedures are not used? Provide examples of problems and propose solutions.

Week 4 DQ 2

What is the main distinction between V and E codes? How are they similar or different? What are your suggestions to streamline the V and E coding process? Explain your answers.

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13

HCR 220 Week 4 CheckPoint Determining Diagnosis Code Categories
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HCR 220 Week 4 CheckPoint Determining Diagnosis Code Categories
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Resource: pp. 130-135 of Medical Insurance
Post a response to the following: Determine a diagnosis code category for the following case studies and explain the rationale for your selections:
A 56-year-old woman presents to the office complaining of pronounced weakness on the right side of her body and slurred speech for the past 18 hours. Based on the examination, the physician orders an MRI to investigate a possible transient ischemic attack (TIA). A 42-year-old man comes to the office complaining of intermittent chest pain. The physician orders an EKG to rule out a possible cardiac event. A 23-year-old diabetic female exhibits a non-healing wound on her left foot.



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14

HCR 220 Week 3 CheckPoint Eligibility, Payment, and Billing Procedures
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HCR 220 Week 3 CheckPoint Eligibility, Payment, and Billing Procedures
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Resource: pp. 86–88 of Medical Insurance

Write a 250 to 300 word response to the following:

Describe a factor that determines patient benefits eligibility.

What are the appropriate steps to take when insurance does not cover a planned service?

Relate these steps to the eligibility factor you identified and provide two examples of patient charges with corresponding billing transactions.

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15

HCR 220 Week 3 Assignment Understanding the Patient Intake Process
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Resource: Figure 3.1 on p. 75 of Medical Insurance
Write a 750 to 1,050 word essay discussing strategies to improve patient intake efficiency not covered in the text. Include the following components in your essay:
Provide at least one must-have item not covered in the text.
Provide a minimum of one reliable reference from the University Library or the Internet



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16

HCR 220 Week 2 DQ 1 And DQ 2
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HCR 220 Week 2 DQ 1 And DQ 2
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Week 2 DQ 1

Summarize the purposes and provisions of HIPAA in one sentence. Also, explain how HIPAA relates to medical ethics and etiquette. What are some possible ramifications of a health care industry without HIPAA regulations? Refer to p. 25 of Medical Insurance and provide examples.

Week 2 DQ 2

How do effective medical compliance plans limit the risk of professional liability? Do you believe it is reasonable to hold a provider liable for the actions of his or her clerical staff? Support your opinion with an example.

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17

HCR 220 Week 2 CheckPoint Medical Records Documentation and Billing
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HCR 220 Week 2 CheckPoint Medical Records Documentation and Billing
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Write a 250 to 300 word response to the following:

Describe how compliance plans correlate to different medical records documentation standards.
Which steps in the medical billing process, listed in Ch. 1 of Medical Insurance, are related to the following:

Compliance plans
Medical records
Documentation standards

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18

HCR 220 Week 1 CheckPoint Payment Methods Presentation
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HCR 220 Week 1 CheckPoint Payment Methods Presentation
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Resources: Appendix B

Create a 4 to 5 slide PowerPoint® presentation in which you describe, in your own words, the fee-for-service and capitation payment cycles. Include the relationship among provider, patient, and payer in your presentation, and their roles in the process.

Include an introduction and conclusion slide in your presentation.

Provide your summarized information on the slides – not in the notes, but do not overload the slides with too much information.

Provide APA-formatted references.

Refer to the Microsoft® Help link for assistance with questions related to PowerPoint®.

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19

HCR 220 Week 1 CheckPoint Features of Health Plans
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HCR 220 Week 1 CheckPoint Features of Health Plans
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Resource: Table 1.1 on p. 13 of Medical Insurance: An Integrated Claims Process Approach

Write and post a 250 to 300 word response to the following questions:



Describe the similarities and differences among the major types of health plans. Do you believe any one plan offers greater financial or coverage benefits to either a consumer or a provider? Explain your answers.

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20

HCR 220 Week 1 Assignment Steps in the Medical Billing Process
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HCR 220 Week 1 Assignment Steps in the Medical Billing Process
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Resource: Figure 1.6 on p. 17 of Medical Insurance

Write a 500 to 750 word paper that lists the sequence of steps in the medical billing process. In your own words, provide a 3 to 4 sentence explanation for each step.

Your paper must be formatted according to APA standards to be graded.

Attach in a Word Document.

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21

HCR 220 Complete Class
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HCR 220 Complete Class
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