Syllabus

|[pic] |HCR 220 Course Syllabus | | |College of Health Sciences and Nursing | | |HCR/220 Version 4 | | |Claims Preparation I: Clean Bills of Health | | |Schedule: 08/19/2013 – 10/20/2013 | | |Group ID: AAGR192HX7 | Copyright © 2013, 2009, 2008 by University of Phoenix. All rights reserved. Course Description Medical records processing revolves around insurance and reimbursement. This course focuses on the background, knowledge, and skills related to basic billing duties, HIPAA regulations, patient encounters, and the preparation, compliance, and transmission of claims. Students are introduced to the current state and future direction of the major diagnostic and procedural coding systems. Policies Faculty and students will be held responsible for understanding and adhering to all policies contained within the following two documents: • University policies: You must be logged into the student website to view this document. • Instructor policies: This document is posted in the Course Materials forum. University policies are subject to change. Be sure to read the policies at the beginning of each class. Policies may be slightly different depending on the modality in which you attend class. If you have recently changed modalities, read the policies governing your current class modality. Course Materials Valerius, J., Bayes, N., Newby, C., & Blochowiak, A. (2014). Medical insurance: An integrated claims process approach (6th ed.). Boston, MA: McGraw-Hill. Associate Level Writing Style Handbook, available online at https://ecampus.phoenix.edu/secure/aapd/CWE/pdfs/Associate_level_writing_style_handbook.pdf All electronic materials are available on the student website. |Week One: Introduction to the Medical Billing Process | | |Details |Due |Points | |Objectives |Compare and contrast features of various health plans. | | | | |Explain capitation and fee-for-service payment methods. | | | | |Explain the basic steps in the medical billing process. | | | |Course Preparation |Read the course description and objectives. | | | | | | | | | |Read the instructor’s biography and post your own. | | | |Reading |Read Appendix A. | | | |Reading |Read Ch. 1 of Medical Insurance. | | | |Individual |Resource: Table 1.2 of Medical Insurance |Day 3 |15 | |Features of Health Plans | | | | | |Write and post a 250- to 300-word response to the following question: | | | | | | | | | |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. | | | | | | | | | |Format your essay consistent with APA guidelines. | | | | | | | | | |Attach the Certificate of Originality and Plagiarism (Turnitin) Report. | | | |Individual |Resource: Appendix B |Day 4 |15 | |Payment Methods Presentation | | | | | |Create a 4- to 5-slide PowerPoint® presentation in which you describe 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. | | | | | | | | | |Provide detailed speaker notes to accompany your presentation. | | | | | | | | | |Provide references if you include sources beyond Medical Insurance. | | | | | | | | | |Refer to the Microsoft® Help link at http://support.microsoft.com/ for assistance | | | | |with questions related to PowerPoint®. | | | | | | | | | |Format your presentation consistent with APA guidelines. | | | |Individual |Resource: Figure 1.5 of Medical Insurance |Day 7 |70 | |Steps in the Medical Billing Process | | | | | |Write a 500- to 750-word paper that lists the sequence of steps in the medical | | | | |billing process. In your own words, provide a three- to four-sentence explanation | | | | |for each step. | | | | | | | | | |Format your essay consistent with APA guidelines. | | | | | | | | | |Attach the Certificate of Originality and Plagiarism (Turnitin) Report. | | | |Nongraded Activities |Possible Chapter(s) Quizzes |Day 6 |0 | | |(posted in the main thread) | | | |Week Two: HIPAA and Medical Records | | |Details |Due |Points | |Objectives | | | | | |Summarize the purposes and provisions of HIPAA. | | | | |Relate ethics and etiquette standards for medical recordkeeping to HIPAA. | | | | |Debate how medical compliance plans limit liability. | | | | |Discuss the relationship between medical records documentation and billing. | | | |Reading |Read pp. 26-28 of Ch. 1 of Medical Insurance. | | | |Reading |Read Ch. 2 of Medical Insurance. | | | |Reading |Read Ch. 3 of Medical Insurance. | | | |Participation and Discussion Questions |Participate in class discussion as well as Respond to weekly discussion questions.|Day 2 |30 | | | |Day 4 | | |Individual |Write a 250- to 300-word response to the following: |Day 5 |30 | |Medical Records Documentation and Billing | | | | | |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 | | | | | | | | | |Format your essay consistent with APA guidelines. | | | | | | | | | |Attach the Certificate of Originality and Plagiarism (Turnitin) Report. | | | |Nongraded Activities |Possible Chapter(s) Quizzes (posted in the main thread) |Day 6 |0 | |Week Three: Patient Encounters and Billing Information | | |Details |Due |Points | |Objectives | | | | | |Describe factors that determine patient eligibility. | | | | |Describe patient charges, billing procedures, and transactions. | | | | |Discuss strategies to improve the patient intake process. | | | |Individual |Resource: pp. 90-93 of Medical Insurance |Day 4 |30 | |Eligibility, Payment, and Billing | | | | |Procedures |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. | | | | |Format your essay consistent with APA guidelines. | | | | |Attach the Certificate of Originality and Plagiarism (Turnitin) Report. | | | |Individual |Resource: Figure 3.1 of Medical Insurance |Day 7 |100 | |Understanding the Patient Intake | | | | |Process |Write a 750- to 1,050-word essay discussing strategies to improve patient intake | | | | |efficiency not covered in Medical Insurance. Include the following components in your | | | | |essay: | | | | | | | | | |Provide at least one must-have item not covered in Medical Insurance. | | | | |Provide at least one reliable reference from the University Library or the Internet. | | | | | | | | | |Format your essay consistent with APA guidelines. | | | | | | | | | |Attach the Certificate of Originality and Plagiarism (Turnitin) Report | | | |Nongraded Activities |Possible Chapter(s) Quizzes (posted in the main thread) |Day 6 |0 | |Week Four: Diagnostic Coding | | |Details |Due |Points | |Objectives | | | | | |Explain the purposes of the Alphabetic Index and Tabular List. | | | | |Discuss V and E codes. | | | | |Determine appropriate diagnosis code categories. | | | |Reading |Read Ch. 18 of Medical Insurance. | | | |Reading |Read Ch. 4 of Medical Insurance. | | | |Reading |Read Ch. 5 of Medical Insurance. | | | |Participation and Discussion |Participate in class discussion as well as Respond to weekly discussion questions. |Day 2 |30 | |Questions | |Day 4 | | |Individual |Resource: pp. 129-132 of Medical Insurance |Day 5 |30 | |Determining Diagnosis Code | | | | |Categories |Write a response in which you determine a diagnosis code category for the following case | | | | |studies, and explain the rationale for your selections. Each rationale/explanation should be| | | | |at least 3 complete sentences: | | | | | | | | | |A 68-year-old male presents to the office complaining of pronounced weakness on the right | | | | |side of his body and slurred speech for the past 24 hours. Based on the examination, the | | | | |physician orders an MRI to investigate a possible transient ischemic attack. | | | | | | | | | |A 44-year-old male presents to the office complaining of intermittent chest pain. The | | | | |physician orders an EKG to rule out a possible cardiac event. | | | | | | | | | |A 72-year-old diabetic female exhibits a nonhealing wound on her left foot. | | | | | | | | | |Format your essay consistent with APA guidelines. | | | | | | | | | |Attach the Certificate of Originality and Plagiarism (Turnitin) Report. | | | |Nongraded Activities |Possible Chapter(s) Quizzes (posted in the main thread) |Day 6 |0 | |Week Five: Procedural Coding: Introduction to CPT | | |Details |Due |Points | |Objectives | | | | | |Describe CPT coding categories. | | | | |Identify CPT modifiers. | | | | |Assign appropriate Evaluation and Management (E/M) codes. | | | |Reading |Review Ch. 5 of Medical Insurance. | | | |Exercise |Resource: Table 5.2 of Medical Insurance |Day 4 |10 | |Working with CPT | | | | |Modifiers |Complete the exercise by identifying the correct Current Procedural Terminology (CPT) modifier | | | | |to its corresponding procedure for the following: | | | | | | | | | |Two Surgeons | | | | |Reduces Services | | | | |Repeat clinical diagnostic laboratory test | | | | |Unusual anesthesia | | | | |Mandated services | | | |Individual |Resource: p. 144 of Medical Insurance |Day 5 |20 | |Describing CPT Coding | | | | |Categories |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 a 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 CPT code categories' | | | | | | | | | |Provide one example for each category in your description. | | | | | | | | | |Format your essay consistent with APA guidelines. | | | | | | | | | |Attach the Certificate of Originality and Plagiarism (Turnitin) Report. | | | |Individual |Resources: Figure 5.4 and Table 5.4 of Medical Insurance |Day 7 |90 | |Assigning E/M Codes | | | | | |Assign appropriate E/M codes for the following cases: | | | | | | | | | |Initial consultation is performed for a 78-year-old woman with unexplained weight loss, | | | | |abdominal pain, and rectal bleeding. A sixty-minute comprehensive history and examination is | | | | |performed. | | | | | | | | | |A 30-year-old patient presents complaining of flu-like symptoms characterized by an unremitting | | | | |cough, sinus pain, and thick nasal discharge. A 20 minute examination reveals bronchitis and | | | | |sinus infection. The patient is prescribed a 5-day course of Zithromax. | | | | | | | | | |An established patient on lithium presents for routine blood work to monitor therapeutic levels | | | | |and kidney function. A nurse reviews the results in five minutes or less and advises the patient| | | | |that tests are normal, and no change in dosage is indicated. | | | | | | | | | |A 62-year-old diabetic female presents for check-up and a dressing change of wound on left foot.| | | | |A twenty-five minute examination reveals the wound is healing. The nurse applied a new dressing | | | | |and the patient will return for a check-up in 1 week. | | | | | | | | | |A mother brings in her 6-month-old male child for a routine wellness check. A forty 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 three complete sentences for | | | | |each case study. | | | | | | | | | |Format your essay consistent with APA guidelines. | | | | | | | | | |Attach the Certificate of Originality and Plagiarism (Turnitin) Report. | | | |Nongraded Activities |Possible Chapter(s) Quizzes (posted in the main thread) |Day 6 |0 | |Week Six: Procedural Coding: Introduction to HCPCS | | |Details |Due |Points | |Objectives | | | | | |Compare permanent codes and temporary codes. | | | | |Explain HCPCS coding steps in the billing process. | | | | |Apply Level II HCPCS modifiers. | | | |Reading |Read Ch. 6 of Medical Insurance. | | | |Reading |Review pp. 183-189 of Medical Insurance. | | | |Participation and Discussion |Participate in class discussion as well as Respond to weekly discussion questions. |Day 2 |30 | |Questions | |Day 4 | | |Individual |Resource: Table 5.7 of Medical Insurance |Day 5 |30 | |Applying Level II HCPCS | | | | |Modifiers |Apply the appropriate Level II Healthcare Common Procedure Coding System (HCPCS) code | | | | |modifier for each of the following examples. Explain your rationale for each selection. Each | | | | |rationale should be at least 3 complete sentences. | | | | | | | | | |Electric hospital bed | | | | |Portable home oxygen unit | | | | |Emergency ambulance transport and extended life support | | | | |Diagnostic mammogram, left breast | | | | |Cortisone 10 mg injection, right shoulder | | | | |Nonelectric wheelchair | | | | |Intravenous catheter line, right arm | | | | |Right hand, ring finger | | | | |Chest X-ray | | | | |Prosthetic hip replacement, left side | | | | | | | | | |Format your essay consistent with APA guidelines. | | | | | | | | | |Attach the Certificate of Originality and Plagiarism (Turnitin) Report. | | | |Nongraded Activities |Possible Chapter(s) Quizzes (posted in the main thread) |Day 6 |0 | |Week Seven: Visit Charges and Compliant Billing | | |Details |Due |Points | |Objectives | | | | | |Discuss the impact of the Medicare National Correct Coding Initiative on medical billing and coding | | | | |processes. | | | | |Evaluate billing compliance strategies. | | | | |Relate physician and payer fees to medical compliance. | | | |Individual |Resource: pp. 198 & 203 of Medical Insurance, and Medical News Today website |Day 5 |20 | |Errors and |(http://www.medicalnewstoday.com/) | | | |Compliance in Coding| | | | | |Review the “Americans Paying for Billing Errors” story at | | | | |http://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. | | | | | | | | | |Format your essay consistent with APA guidelines. | | | | | | | | | |Attach the Certificate of Originality and Plagiarism (Turnitin) Report. | | | |Individual |Write a 750- to 1,050-word essay evaluating billing and coding compliance strategies. Provide an |Day 7 |80 | |Evaluating |overview of the compliance process, and offer your judgment either supporting or criticizing a | | | |Compliance |particular method. Make suggestions for improvement at the end of your evaluation. | | | |Strategies | | | | | |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 at least one reliable reference from the University Library or the Internet. | | | | | | | | | |Format your essay consistent with APA guidelines. | | | | | | | | | |Attach the Certificate of Originality and Plagiarism (Turnitin) Report. | | | |Nongraded Activities|Possible Chapter(s) Quizzes (posted in the main thread) |Day 6 |0 | | | | | | |Week Eight: Health Care Claim Preparation and Transmission | | |Details |Due |Points | |Objectives | | | | | |Compare the role of HIPAA 837 with CMS-1500 in the claim process. | | | | |Explain the importance of preparing and submitting “clean claims.” | | | | |Complete a CMS-1500 claim form. | | | |Reading |Read Ch. 7 of Medical Insurance. | | | |Participation and |Participate in class discussion as well as Respond to weekly discussion questions. |Day 2 |30 | |Discussion Questions | |Day 4 | | |Individual |Complete the CMS-1500 claim form worksheet in Appendix C. If you believe the information in the |Day 5 |30 | |Complete a CMS-1500 Claim |following list is insufficient to adequately fill a required field with data, such as supplying a| | | |Form |specific diagnosis code, indicate this by typing N/A. If no patient information has been given | | | | |for a specific field, leave it blank. | | | | | | | | | |Name: Katherine Doe | | | | |Insurer: TRICARE | | | | |Policy Number: 678941 | | | | |ID number: 999000666 | | | | |DOB: 01/01/1950 | | | | |Gender: Female | | | | |Insured: James Doe, spouse | | | | |Address: 1111 Noname Court, Nowhere, NY 22222 | | | | |Marital Status: Married | | | | |Patient’s Employer: Homemaker | | | | |Spouse’s Employer: U.S. Navy | | | | |Nature of Condition: Routine exam | | | | |Patient Signature: | | | | | | | | | |Include ICD categories, CPT, HCPCS, and insurance information, only if you were provided | | | | |sufficient information. | | | | |If you believe there is insufficient information provided to fill a required field with data, | | | | |indicate this by typing N/A. | | | | |This not a CPT coding assignment. | | | |Nongraded Activities |Possible Chapter(s) Quizzes (posted in the main thread) |Day 6 |0 | |Week Nine: Summarizing the Medical Billing Process | | |Details |Due |Points | |Objectives | | | | | |Relate HIPAA, ICD, CPT, and HCPCS to the medical billing process. | | | | |Illustrate the billing process using the CMS-1500 form. | | | | |Discuss social, legal, and ethical ramifications of HIPAA violations. | | | |Capstone Individual |Post a 250- to 300-word response in which you explain how the Health Insurance |Day 4 |40 | | |Portability and Accountability Act (HIPAA), International Classification of Diseases | | | | |(ICD), CPT, and HCPCS influence each of the 10 steps of the medical billing process. | | | | | | | | | |Format your essay consistent with APA guidelines. | | | | | | | | | |Attach the Certificate of Originality and Plagiarism (Turnitin) Report. | | | |Final Project |Resource: Appendix A |Day 7 |135 | |Complete the CMS claim form: Part | | | | |One |Refer to Table 7.3 of Medical Insurance 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: Jamie Brown | | | | |Account Number: 090911 | | | | |Insurer: Medicare | | | | |Policy Number: 1098765 | | | | |ID number: 12345678910 | | | | |DOB: 02/01/1940 | | | | |Gender: Female | | | | |Insured: Jamie 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, CPT, HCPCS, and insurance information, only if you were provided | | | | |sufficient information. | | | | |If you believe there is insufficient information provided to fill a required field with | | | | |data, indicate this by typing N/A. | | | | |This not a CPT coding assignment. | | | | | | | | | |Post the completed CMS-1500 form as an attachment. | | | |Final Project |Write a 1,500- to 1,750-word essay in which you discuss implications of both forms of the|Day 7 |135 | |How HIPAA Violations Affect the |patient’s diseases, HIV and AIDS, from the perspective of HIPAA confidentiality. Include | | | |Medical Billing Process: Part Two |the following: | | | | | | | | | |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 at least three references from the University Library or the Internet. | | | | | | | | | |Format your essay consistent with APA guidelines. | | | | | | | | | |Attach the Certificate of Originality and Plagiarism (Turnitin) Report. | | | |Nongraded Activities |Possible Chapter(s) Quizzes (posted in the main thread) |Day 6 |0 | Copyright University of Phoenix® is a registered trademark of Apollo Group, Inc. in the United States and/or other countries. Microsoft®, Windows®, and Windows NT® are registered trademarks of Microsoft Corporation in the United States and/or other countries. All other company and product names are trademarks or registered trademarks of their respective companies. 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