HCR 203 Entire Course

HCR 203 Entire Course

Entire Course Link

https://zh.scribd.com/document/340327850/Uop-Tutorial

 

 HCR/203

MEDICAL CLAIMS PROCESSING AND COMPLIANCE

 

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HCR 203 Entire Course Link

https://uopcourses.com/category/hcr-203/

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HCR 203 Week 1 Build Your Resume for Success
 

As you work through the completion of your coursework, it is important that you have a quality resume and cover letter to submit to potential employers. This assignment along with the cover letter assignment in Week Two are designed to give you the tools and the confidence to build and submit quality resumes and cover letters.

Navigate to the Phoenix Career Guidance™ Dashboard.

In the Build your Resume section, click Go to the Resume Builder at the bottom of the page.

Complete your resume by following the prompts provided in the builder.

After you have completed your resume, click “Publish” and then select “Export (PDF or DOC)” to save a copy to your computer.

Click the Assignment Files tab to submit your assignment.

 

 

 

HCR 203 Week 1 Week One Worksheet
 

Complete the University of Phoenix Materials: Week One Worksheet.

Click the Assignment Files tab to submit your assignment.

Week One Worksheet

 

Part A: The Billing Cycle

 

Resource: Ch.1 of Medical Insurance, The Medical Billing Cycle diagram located in Ch. 1 of the Medical Insurance textbook

 

Review the Medical Billing Cycle diagram located in Ch. 1 of your textbook.

 

Complete the table below by identifying 2-3 steps in the billing cycle you think are the most important in medical billing. Be clear and concise, use complete sentences, and use your own words.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Step
Description
 
 
 
 
 
 
 
 
 

 

Part B: Paper versus Electronic Claims

 

Write 150- to 350-word responses to each of the following questions. Be clear and concise, use complete sentences, and explain your answers using specific examples.

 

Cite any outside sources. For additional information on how to properly cite your sources check out the Reference and Citation Generator resource in the Center for Writing Excellence.

 

 

 

 

Discuss the advantages and disadvantages of paper versus electronic claims submission? Explain your answer.
 

 

 

 

 

 

Under what circumstances will a claim not able to be submitted electronically?
 

 

 

 
 

 

 

HCR 203 Week 1 Clean Claims Worksheet
 

Complete the University of Phoenix Materials: Clean Claims Worksheet.

Click the Assignment Files tab to submit your assignment.

Clean Claims Worksheet

 

Resources: Ch. 7 of Medical Insurance

 

Review the table below.

 

Highlight the simple errors in the table below that keep practices from generating a clean claim.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Simple Errors
Not using prefixes for people’s names (i.e., Mr., Ms., Dr.)
Missing or incomplete service facility name, address, and identification for services rendered outside the office or home
Not using hyphens, dashes or spaces in telephone numbers
Invalid zip codes or state abbreviations
Invalid procedure codes
Incomplete other payer information. This is required for all secondary claims and all primary claims that will involve a secondary payer
Missing or invalid patient birth date
 

Write 150- to 350-word responses to the following questions. Use your own words and provide examples to support your answers.

 

Cite any outside sources. For additional information on how to properly cite your sources check out the Reference and Citation Generator resource in the Center for Writing Excellence.

 

 

 

 

Why is it important to review claims prior to submission? Explain
 

 

 

 

 

 

Why is it important to know how to properly search for or use resources in the medical office to verify information?
 

 

 

 
 

 

HCR 203 Week 2 Write a Great Cover Letter

Navigate to the Phoenix Career Guidance™ Dashboard.

Review the Write a Great Cover Letter section.

Compose a cover letter using Microsoft® Word.

Click the Assignment Files tab to submit your assignment.

 

 

 

 

HCR 203 Week 2 Claims Process Summary
 

Write a 350- to 700-word summary that discusses the following:

 

 

 

How are the data elements in the Health Insurance Portability and Accountability Act (HIPAA) 837 claim form similar to the CMS-1500?
 

 

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 answer.
 

 

Cite any sources. For additional information on how to properly cite your sources, log onto the Reference and Citation Generator resource in the Center for Writing Excellence.

Format your assignment according to APA guidelines.

Click the Assignment Files tab to submit your assignment.

 

 
 

 

 

HCR 203 Week 2 CMS-1500 Claim Form Worksheet
 

Resource: CMS-1500 completed claim form and this week’s readings

Complete the University of Phoenix Material: CMS-1500 Claim Form Worksheet.

Click the Assignment Files tab to submit your assignment.

CMS-1500 Claim Form Worksheet

 

Complete Part A, B and C of this worksheet.

 

Resource: CMS-1500 Completed Claim Form and Ch. 7 and 17 of Medical Insurance

 

Part A: CMS-1500 Claim Form

 

Imagine you are working at a local medical office as a billing specialist. You are asked to audit the CMS-1500 claim form completed by a new employee to ensure it was completed correctly.

 

Review the Patient Information, Provider Information and Treatment Information.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Provider Information
 
Patient Information
Name
John Brown, MD
 
Name
Kevin Luke
Address
12123 South High Street, St. Paul, OH 77831
 
Sex
Male
Telephone
202- 445-0000
 
Birth Date
09/02/1966
Employer ID
00-8885674
 
Address
2233 Campus Ct., Iowaville, Ohio, 77832
NPI
9988775544
 
SSN
000-01-0101
Signature
On file (1-1-2015)
 
Health Plan
Medical Health PPO
 
 
 
Insurance ID number
2229998-23
Treatment Information
 
Group Number
OH333
Dates of Service
01/01/2014
 
Employer
LVL Trucking Inc.
Place of Service
11
 
Account number
18993
CPT
95810- Charge $1100.00 x1
 
 
 
Diagnosis
32723- Sleep apnea
 
 
 
 

 

Review the CMS-1500 Completed Claim Form document.

 

Determine if the employee input the correct data and completed correctly the data fields in the claim form.

 

Complete the table below by listing the data field completed incorrectly and providing both the incorrect entry and correct entry. An example has been provided.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Data Field
Incorrect entry
Correct entry
#26
Patient’s account number listed as 12998
Correct account number is 18993
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 

Write 50- to 150-word response to the following question. Be clear and concise, use complete sentences, and explain your answers using specific examples.

 

Cite any outside sources. For additional information on how to properly cite your sources check out the Reference and Citation Generator resource in the Center for Writing Excellence.

 

 

 

 

Explain the importance of complete and accurate completion of the claim form prior to claim processing.
 

 

 

 

 

 

How can the payment plan affect reimbursement?
 

 

 

Part B: Patient and Insurance Information Section of the CMS-1500 Claim Form

 

Review the Patient Information.

Patient Information

 

Determine the appropriate content for each Data Field Number listed. An example has been provided.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Data Field Number
Data Field Content
1
Medicare
1a
 
2
 
3
 
4
 
5
 
6
 
 

 

Part C: Physician or Supplier Information Section of the CMS-1500 Claim Form

 

Review the note below.

Determine the appropriate content for each Data Field Number listed. An example has been provided.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Data Field Number
Date Field Content
21
790.22
24
 
24 F
 
25
 
26
 
28
 
32
 
33
 
 

 

 

 
 

 

 

HCR 203 Week 2 UB-04 Form Worksheet
 

Complete the University of Phoenix Material: UB-04 Form Worksheet.

Click the Assignment Files tab to submit your assignment.

UB-04 Form Worksheet

 

Resources: Section 17.6 in Ch.17 of Medical Insurance, Table 17.1 “UB-04 Form Completion” and Figure 17.4 “UB-04 Form”

 

Review the resources listed above.

 

Complete the tables below.

 

Determine the data field number the data given should be placed on the UB-04 form. An example has been provided.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Data Field Number
Data
3a
The patient control number
 
The patient name
 
The patient’s date of birth
 
Admission Date
 
Source of admission-Point of origin of admission
 
Admission Hour
 
Occurrence codes
 
Revenue codes
 
Revenue code description
 
Total charges
 
Estimated amount due
 
Insured’s Name
 
Insured’s Group number
 
Diagnosis codes
 
Procedure codes
 
Principal diagnosis
 
Admitting diagnosis
 
External cause of injury
 
Attending provider’s name
 
Operating physician’s name
 

 

Determine the data that needs to be listed under the data field number given of the UB-04 form. An example has been provided.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Data Field Number
Data
1
Provider’s name and address
3b
 
5
 
9
 
13
 
14
 
17
 
18-28
 
29
 
39-41
 
 

 

 

 
 

 

 

HCR 203 Week 3 RA/EOB Summary
 

Write a 350- to 700-word summary that discusses the following:

 

 

 

What is the difference between an RA and an EOB?
 

 

Do you think the RA/EOB is an effective method of communicating claim adjudication information to patients?
 

 

If you have received an RA/EOB, is it easy or difficult to understand?
 

 

What suggestions would you make to improve patient-payer communication regarding the claim adjudication process? Explain your answers.
 

 

Cite any sources. For additional information on how to properly cite your sources, log onto the Reference and Citation Generator resource in the Center for Writing Excellence.

Format your assignment according to APA guidelines.

Click the Assignment Files tab to submit your assignment.

 

 
 

 

 

HCR 203 Week 3 Purpose of the General Appeals Process
 

Resource: Ch. 13 of Medical Insurance: An Integrated Claims Process Approach (6th ed.)

Research the Internet to locate three examples of claims denials and classify them into the following categories:

 

 

 

Coding errors
 

 

Registration mistakes
 

 

Billing errors
 

 

Payer requests
 

 

Write a 150- to 350-word response to the following:

Briefly describe the purpose of the general appeals process. Incorporate the three additional examples of claims errors you located on the Internet, classified according to the categories in the text.

Cite any sources. For additional information on how to properly cite your sources, log onto the Reference and Citation Generator resource in the Center for Writing Excellence.

Format your assignment according to APA guidelines.

Click the Assignment Files tab to submit your assignment.

 

 
 

 

 

HCR 203 Week 4 Effective Financial Policies and Procedures
 

Resource: Ch. 14 of Medical Insurance: An Integrated Claims Process Approach (6th ed.)

Refer to Figures 14.1 and 14.2 in Ch. 14 of Medical Insurance: An Integrated Claims Process Approach (6th ed.).

Post a 350- to 700-word response to the following:

The three major elements to critical thinking are logical inquiry, problem solving, and evaluative decision making. For this assignment, you must exercise critical-thinking skills to answer the following questions:

 

 

 

What are the basic elements of an effective medical office financial policy?
 

 

In what ways do medical office procedures support financial policies?
 

 

What are the consequences when office procedures do not support the financial policy?
 

 

What recommendations, strategies or tools can medical offices use to ensure effective alignment of policies and procedures?
 

 

Cite any sources. For additional information on how to properly cite your sources, log onto the Reference and Citation Generator resource in the Center for Writing Excellence.

 

 
 

 

 

HCR 203 Week 4 Understanding the Collection Process
 

Resources: Ch. 14 of Medical Insurance: An Integrated Claims Process Approach (6th ed.) and Microsoft® Help website

Refer to Microsoft® Help website for questions related to creating a flowchart in Microsoft® Word®.

Imagine you are working at a local medical office and have been asked to train the new billing specialist on the collections process.

Create a flowchart using Microsoft® Word® that illustrates the sequence of basic steps in the collection process.

Write a 350- to 700-word script below your flowchart that could be used for a short instructional video to accompany the flowchart. The script must provide an overview of how to use the flowchart when dealing with a collections account.

Include details about what to do at each step in the flowchart.

Cite any sources. For additional information on how to properly cite your sources, log onto the Reference and Citation Generator resource in the Center for Writing Excellence.

Format your assignment according to APA guidelines.

Click the Assignment Files tab to submit your assignment.

 

 
 

 

 

HCR 203 Week 4 Ch. 14 Online Quiz
 

Resource: Ch. 14 online quiz

Access the Ch. 14 Medical Insurance online quiz relating to guidelines for patient accounts

Complete the quiz and click the Submit button.

Create a screenshot of the completed quiz.

To take a screenshot, follow these directions:

 

 

 

Press Alt + Print Screen on your computer keyboard to create a screenshot.
 

 

Open a blank Microsoft® Word document.
 

 

Press Ctrl + V on your keyboard to paste the screenshot into the document.
 

 

Save the document to your computer, and submit the document to your instructor.
 

 

Click the Assignment Files tab to submit your assignment.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

An appeal is sent to third-party payers before a questionable claim is transmitted.
 
 
 
A)
True
 
 
B)
False
 
 
 
 
 
 
 
2
 
 

The claimant is the person or entity who seeks to receive benefits.
 
 
A)
True
 
 
B)
False
 
 
 
 
 
 
 
3
 
 

The claim turnaround time is the period between the patient’s encounter and the transmission of the resulting claim.
 
 
A)
True
 
 
B)
False
 
 
 
 
 
 
 
4
 
 

Medical insurance specialists follow up on claims that are not processed within the specified claim turnaround time for the payer.
 
 
A)
True
 
 
B)
False
 
 
 
 
 
 
 
5
 
 

An example of concurrent care is a case in which a patient is attended by two physicians, such as a cardiologist and a thoracic surgeon, during surgery.
 
 
A)
True
 
 
B)
False
 
 
 
 
 
 
 
6
 
 

The determination of a claim refers to the payer’s decision regarding payment.
 
 
A)
True
 
 
B)
False
 
 
 
 
 
 
 
7
 
 

An insurance aging report lists the practice’s patients, their insurance information, and their ages.
 
 
A)
True
 
 
B)
False
 
 
 
 
 
 
 
8
 
 

A medical necessity denial occurs when a procedure is halted by a provider because of the patient’s condition.
 
 
A)
True
 
 
B)
False
 
 
 
 
 
 
 
9
 
 

A medical review program is established by a third-party payer.
 
 
A)
True
 
 
B)
False
 
 
 
 
 
 
 
10
 
 

A utilization review is conducted by provider to check the medical necessity of claims before they are transmitted.
 
 
A)
True
 
 
B)
False
 

 

 

 

HCR 203 Week 5 Medical Compliance Plan
 

Write a 1,500- to 1,750-word essay in which you create a medical compliance plan for a medical office of your choice. Include the following in your essay:

 

 

 

Compliance plan objectives
 

 

Standards of conduct
 

 

Purposes and provisions of HIPAA
 

 

Discuss social, legal, and ethical ramifications of HIPAA violations
 

 

HIPAA requirements for claims submission
 

 

Discuss how medical compliance plans limit liability
 

 

Conflicts of interest
 

 

Auditing and monitoring
 

 

Communication process
 

 

Reporting
 

 

Cite any sources. For additional information on how to properly cite your sources, log onto the Reference and Citation Generator resource in the Center for Writing Excellence.

Format your assignment according to APA guidelines.

Click the Assignment Files tab to submit your assignment.

 

 

 

HCR 203 Week 5 Signature Assignment: Medical Compliance Plan
 

Write a 1,050- to 1,400-word essay in which you create a medical compliance plan for an office of your choice. Include the following in your plan:

 

 

 

Identify compliance plan objectives that support the purpose of a compliance plan
 

 

Explain how medical compliance plans limit liability
 

 

Explain basic employee standards of conduct relevant to compliance
 

 

Explain HIPAA requirements and detail key elements 

 

 

 

Release of patient information
 

 

Consent forms
 

 

Patient responsibility
 

 

Informed and implied consent
 

 

Use and disclosure
 

 

 
 

 

 

 

 

Explain ramifications of HIPAA violations
 

 

Explain conflicts of interest and the potential impact on compliance
 

 

Explain auditing, monitoring, and reporting procedures that support compliance
 

 

Explain elements of a basic communication process to share updates across the organization
 

 

Cite any outside sources. For additional information on how to properly cite your sources check out the Reference and Citation Generator resource in the Center for Writing Excellence.

Click the Assignment Files tab to submit your assignment.
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