- Description
HCR/203
MEDICAL CLAIMS PROCESSING AND COMPLIANCE
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HCR 203 Entire Course Link
https://hwsell.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.