• Share
  • Email
  • Embed
  • Like
  • Save
  • Private Content
Issues and Trends in HBI Ch 7
 

Issues and Trends in HBI Ch 7

on

  • 626 views

 

Statistics

Views

Total Views
626
Views on SlideShare
323
Embed Views
303

Actions

Likes
0
Downloads
2
Comments
0

1 Embed 303

http://moodle.richmondcc.edu 303

Accessibility

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment
  • Teaching Notes: <br />  Suggest to students that they review the key terms in this chapter prior to reading the chapter or hearing the lecture. This will enhance their understanding of the material. <br />   <br />
  • Learning Outcome: 7.1 Distinguish between the electronic claim transaction and the paper claim form. <br /> Teaching Notes: <br />   <br /> Ask each student to provide the common names for the HIPAA X12 837 Health Care Claim or Equivalent Encounter Information (the “837 claim” or the “HIPAA claim”) and to explain how standardization can reduce errors. <br /> Discuss the disadvantages of the CMS-1500 paper claim form and the merits of electronic claims transactions. <br />
  • Learning Outcome: 7.1 Distinguish between the electronic claim transaction and the paper claim form. <br /> Teaching Notes: <br />   <br /> Ask students to identify and discuss the changes HIPAA has made on the payer side of claim transaction (payers may not require providers to make changes or additions to the content of the HIPAA 837 claim, and they cannot refuse to accept the standard transaction or delay payment of any proper HIPAA transaction, claims included). <br />   <br /> Discuss the advantages of the 5010 version electronic claims transactions. <br />
  • Learning Outcome: 7.2 Discuss the content of the patient information section of the CMS-1500 claim. <br /> Teaching Notes: <br />   <br /> Ask students to identify and describe the required information to complete the carrier block (the carrier block allows for a four-line address for the payer). <br /> Note that in some cases, IN 10D may require a condition code; correct codes can be researched on the NUCC website. <br />
  • Learning Outcome: 7.2 Discuss the content of the patient information section of the CMS-1500 claim. <br /> Teaching Notes: <br />   <br /> Identify and discuss each Item Number (1-13) in the patient information section of the CMS-1500 claim. <br />   <br /> Ask students to explain how the information in the patient information section is used in the reimbursement process. <br />
  • Learning Outcome: 7.3 Compare billing provider, pay-to provider, rendering provider, and referring provider. <br /> Teaching Notes: <br />   <br /> Ask students to describe the role of the four different listed types of providers. <br />
  • Learning Outcome: 7.4 Discuss the content of the physician or supplier information section of the CMS-1500 claim. <br /> Teaching Notes: <br />   <br /> Examine and discuss the contents of Table 7.1 with students. <br /> Ask students to describe how other ID numbers, qualifiers, and reporting outside laboratory services help in the reimbursement process. <br /> . <br />
  • Learning Outcome: 7.4 Discuss the content of the physician or supplier information section of the CMS-1500 claim. <br /> Teaching Notes: <br />   <br /> Examine and discuss POS codes and their descriptions (found in Table 7.2) with students. <br /> Ask students to explain how taxonomy codes and administrative code sets improve healthcare reimbursement. <br />
  • Learning Outcome: 7.4 Discuss the content of the physician or supplier information section of the CMS-1500 claim. <br /> Teaching Notes: <br />   <br /> Examine and discuss the Item Numbers in the physician/supplier information section of the CMS-1500 claim. <br /> Ask students to discuss why accuracy is important here and to provide three strategies of how to ensure accuracy on the job. <br />
  • Learning Outcome: 7.5 Explain the hierarchy of data elements on the HIPAA 837 claim. <br /> Teaching Notes: <br />   <br /> Ask students to give some examples of data elements and explain how they help the reimbursement process. <br />   <br /> Discuss with students the differences between a required data element and a situational data element. <br />
  • Learning Outcome: 7.6 Categorize data elements into the five sections of the HIPAA 837P claim transaction. <br /> Teaching Notes: <br />   <br /> Examine the details of the five sections of the HIPAA 837 claim transaction with students (see the five sections listed on this slide). <br /> Ask students to explain how each section of the HIPAA 837 helps to ensure accurate reimbursement from third-party payers. <br />
  • Learning Outcome: 7.6 Categorize data elements into the five sections of the HIPAA 837P claim transaction. <br /> Teaching Notes: <br />   <br /> Examine and discuss with students the significance of the claim filing indicator and individual relationship codes. <br /> Ask students to explain how the destination payer and responsible party affect patient and provider. <br />
  • Learning Outcome: 7.6 Categorize data elements into the five sections of the HIPAA 837P claim transaction. <br /> Teaching Notes: <br />   <br /> Examine and discuss with students the significance of the claim control number and line item control numbers. <br /> Ask students to explain how the claim frequency codes and claim attachment forms affect reimbursement. <br />
  • Learning Outcome: 7.7 Evaluate the importance of checking claims prior to submission, even when using software. <br /> Teaching Notes: <br />   <br /> Ask students to identify and list common errors that can occur when completing a claim (missing or incomplete information; missing Medicare or benefits assignment indicator; invalid provider identifier; missing or invalid patient data; missing payer name and or/identifier; incomplete other payer information; invalid procedure codes; etc.). <br /> Examine and discuss with students strategies to improve accuracy when completing a claim (double checking, teamwork, software scrubbers, clearinghouse, etc.). <br />
  • Learning Outcome: 7.8 Compare the three major methods of electronic claim transmission. <br /> Teaching Notes: <br />   <br /> Have students debate the value of the direct transmission approach for the transmission of electronic claims. <br /> Provide examples of the types of errors scrubbers can be expected to catch. <br />

Issues and Trends in HBI Ch 7 Issues and Trends in HBI Ch 7 Presentation Transcript