HCS 182 Week 3 Health Care Billing

Resource: Health Care Billing Worksheet

Complete Parts A, B, and C of the Health Care Billing Worksheet.

Click the Assignment Files tab to submit your assignment.

Part A: Match the appropriate term to its definition.

1.	_______ Provider Liability for Overpayments	A.	Mandated to find and correct improper Medicare payments made to providers.
2.	_______ Medicare Share Savings	B.	Medicare providers responsible for overpayment for claims that do not meet medical necessity, correct coding initiatives, or have documentation to support codes reported on claims.
3.	_______ Recovery Audit Contractors	C.	Medicare program introduced in 1996 to reduce expenditures due to inappropriate codes submitted on claims.
4.	_______ Medicaid Integrity Program	D.	Ensure the availability of records for governmental and other third-party agencies, time mandated by federal or state regulations.
5.	_______ HIPAA	E.	Provides funds to combat fraud, waste, and abuse of those providers seeking reimbursement from Medicaid.
6.	_______ Retention of Records	F.	Program to facilitate coordination and cooperation to improve the quality of care for Medicare fee-for-service beneficiaries.
7	_______ National Correct Coding Initiative	G.	Provides federal protections for individually identifiable health information held by covered entities and their business associates and gives patients an array of rights with respect to that information.

Part B: Match the appropriate term to its definition.

1.	_______ Evaluation and Management Codes	A.	Includes physician work, practice expenses, and malpractice cost.
2.	_______ Modifiers	B.	Used in most evaluation and management and CPT codes to describe a patient visit and level of complexity of the visit.
3.	_______ Levels of Coding Key Components	C.	Two-digit codes added to the five digit CPT codes to further define the service procedure.
4.	_______ ICD-10-PCS Codes	D.	Used for office and outpatient services.
5.	_______ Relative Value Unit	E.	Used to code medical necessity.
6.	_______ Revenue Codes	F.	A document sent to the patient and provider from the insurance payor that explains how the reimbursement amount for services is determined.
7.	_______ Explanation of Benefits	G.	An explanation of benefits document that is sent to the physician. It is a complete summary of all benefits paid to a provider for services completed for patients during a certain period of time.
8.	_______ Remittance Advice	H.	Health care given to low income patients for free or at a reduced rate.
9.	_______ Write-Off	I.	The part of a charge that is eventually paid by no one.
10.	_______ Contractual Allowance	J.	Amount of a charge is not allowed the insurance payor.
11.	_______ Charity Care	K.	Used to code hospital inpatient treatments and services.
12.	_______ ICD-10-CM	L.	A four-digit code on a facility’s charge master to indicate the location or type of service provided to an institutional patient.

Part C: Read the following scenarios and answer the questions that follow.

Mary presents her BCBS card to the office, which indicates that she has a $20.00 copay. The charges for her services that day are $120.00 for an office visit. How much should be collected at the time of service?

Sherrie needs to balance her cash drawer to complete the end of day close process. Her day sheet totals are as follows:

Patient Name	Charges	Payment Type	Amount Paid	Anticipated Insurance Balance	Patient Balance
Joe Disney	150.00	Cash	25.00	125.00	0
Angela Murray	50.00	Visa	10.00	40.00	0
Shawna Johnson	300.00	Check	25.00	200.00	75.00
Misty Smith	500.00	Check	80.00	420.00	0
Kevin Gold	325.00	Visa	325.00	0	0
Robert Lane	775.00	Cash	75.00	600	25.00
Thomas Newman	185.00	American Express	85.00	0.00	100.00
Patricia Gorman	72.00	MasterCard	0.00	72.00	0.00
Alice Orange	433.00	Cash	162.00	200	71.00
TOTALS

What is the total amount of receivables due for the day? What amount is patient and what amount is anticipated insurance?