West Consulting Network Design SummaryNTC320 v31West Consul.docx

West Consulting Network Design Summary
NTC/320 v3
1
West Consulting Network Design SummaryWest Consulting
Business Description
West Consulting is a graphic design and printing company. It is
growing in consumer and sales volume and therefore, is
expanding its local campus in Houston, Texas and adding a test
location in China.Business Problem
As a graphics design and printing company, West Consulting
runs bandwidth-intensive applications from servers housed at
their headquarters in Houston, Texas. IT leadership has
determined that the current network continuously runs in a
degraded state and users experience heavy latency when
accessing the servers that house their customer Computer Aided
Design (CAD) software.
Due to increased sales of their CAD designs, they need to
expand their facilities. The company headquarters currently has
1,000 unique users amongst their two buildings and has decided
to add another building and 500 users.
In addition, leadership has decided to expand into China to
enable them to test their designs in a new and growing market.
The footprint in China will be relatively small; approximately
30 people.
Solution

You are a Network Consultant for West Consulting. You are
tasked with proposing an improved network design to support
their growth and expansion plans.Requirements
1. A secure WLAN solution in the new building for half of the
users and recommendations to upgrade their existing WLAN
infrastructure to keep wiring costs down.
2. Recommendations on a Unified Communications system that
meets traffic demands, with minimal interruptions, due to the
frequency of international videoconferencing calls that will
occur.
3. An IP solution that can accommodate the new users in all
locations.
4. Recommendations to upgrade their switch bandwidth to 10GB
fiber uplinks between backbone switches, a 10GB connection to
each of the servers, and add-in options for redundancy. High
availability access to these critical servers is a must because of
the expected traffic increase and load on the servers.
5. Proposal for a data center solution that takes advantage of
both network and server virtualization technologies to reduce
their costs in acquiring and maintaining hardware.
6. Improvements to the link speed to the internet.
7. Options for implementing greater security for their Intranet
servers that their partners and employees heavily use and for
their overall network infrastructure, as they have had attacks on

their DMZ.
8. Have proof that these improvements will be completed within
a 4- to 6-month timeline.
Network Configuration Details
The Network Engineer verbally shared the configuration details
of their network, as follows:Headquarters:
· Bldg. 1 and Bldg. 2 are located about 1000 ft. apart. Switches:
· Bldg. 1 has one 6500 backbone switch installed; which
supports users from both buildings.
· Bldg. 2 has a connection to the backbone switch via a 10GB
fiber connection (10G Base LR) from uplink port on a Cisco
3850.
· To support the users, each floor contains three Cisco Catalyst
48-port 100Mbps Ethernet switches; which are each cabled to
the backbone switch via a 1GB uplink port. Routers:
· Each floor represents a different subnet and therefore one
Cisco router 2610, configured with EIGRP, is cabled to
backbone switch (1GB connection) to provide routing for each
subnet and provides a WAN interface to the Internet via a T-1
link.
· Each switch also has a link to an access point that uses WPA
encryption and 802.11b wireless standard to support users who
are in conference/meeting rooms that want to connect to the
internet.Servers:

· 5x Windows® Server 2012 R2 (RAID 5) application servers
that support the CAD.
· 1 DHCP and FTP server
IP Configuration (DHCP-based)
Building
Floor
Servers
Clients
IP Network
1
1
5
100
194.100.1.0/24
2
100
194.100.2.0/24
3
100
194.100.3.0/24

4
100
194.100.4.0/24
5
100
194.100.5.0/24
2
1
5
100
195.100.1.0/24
2
100
195.100.2.0/24
3
100
195.100.3.0/24

4
100
195.100.4.0/24
5
100
195.100.5.0/24
Copyright © 2017 by University of Phoenix. All rights
reserved.
CHAPTER
© 2012 The McGraw-Hill Companies, Inc. All rights
reserved.McGraw-Hill
9
Checkout Procedures

Learning Outcomes
When you finish this chapter, you will be able to:
9.1 List the six steps in the charge capture process.
9.2 Explain the purpose of auditing diagnosis and
procedure code assignment.
9.3 Discuss the effect of health plans’ rules on billing.
9.4 Describe the use of CPT/HCPCS modifiers to
communicate billing information to health plans.
9.5 Discuss strategies to avoid common coding/billing
errors.
9-2

Learning Outcomes (Continued)
9.6 Explain the difference between posting charges from
a paper encounter form and posting charges from an
electronic encounter from.
9.7 Identify the types of payments that may be collected
following a patient’s visit.
9.8 Identify the steps needed to create walkout receipts.
9.9 Describe the use of a patient education feature in an
electronic health record.

9-3
Key Terms
• accept assignment
• addenda
• adjustments
• bundled code
• CCI column 1/column 2
code pair edits
• CCI edits
• CCI modifier indicator

• CCI mutually exclusive
code (MEC) edits
• charge capture
9-4
• charges
• claim scrubbing
• code linkage
• compliant billing
• Correct Coding Initiative
(CCI)
• global period
• medically unlikely edits

(MUEs)
• modifier
• MultiLink codes
Key Terms (Continued)
• package
• payments
• place of service (POS)
code
• query
• real-time claim

adjudication (RTCA)
• self-pay patients
• unbundling
• walkout receipt
9-5
9.1 Overview: Charge Capture Process 9-6
• Charge capture—process of recording billable
services
• The six steps of the charge capture process:
– Step 1: Access encounter data.

– Step 2: Audit coding compliance.
– Step 3: Review billing compliance.
– Step 4: Post charges.
– Step 5: Calculate, collect, and post time-of-service
(TOS) payments.
– Step 6: Check out patient.
9.1 Overview: Charge Capture Process
(Continued)
9-7
• Charges—amount a provider bills for performed
health care services

• Payments—money paid by patients and health
plans
• Adjustments—changes to a patient’s account
9.2 Coding Compliance 9-8
• Physician practices audit medical coding to
ensure maximum appropriate reimbursement
– Codes/claims must be current and accurate for
reimbursement.
– Code linkage and medical necessity must be shown.
• Addenda—updates to ICD-9-CM

• Claim scrubber—software that checks claims to
permit error correction
• Code linkage—clinically appropriate connection
between a provided service and a patient’s
condition or illness
9.3 Billing Compliance 9-9
• Health plans and government payers reimburse
practices according to their own negotiated or
government-mandated fee schedule.
– Health plans issue many billing rules that govern what

will and will not be covered.
– Medical practices must comply to be reimbursed.
• Compliant billing—billing actions that satisfy
official requirements
• Package—combination of services included in a
single procedure code
9.3 Billing Compliance (Continued) 9-10
• Bundled code—two or more related procedure
codes combined into one
• Global period—days surrounding a surgical

procedure when all services relating to the
procedure are considered part of the surgical
package
• Correct Coding Initiative (CCI)—computerized
Medicare system that prevents overpayment
• CCI edits—CPT code combinations that are
used by computers to check Medicare claims
• Unbundling—incorrect billing practice of
breaking a panel or package of

services/procedures into component parts
• CCI column 1/column 2 code pair edits—
Medicare code edit in which CPT codes in
column 2 will not be paid if reported for same
day of service, for the same patient, and by the
same provider as the column 1 code
• CCI mutually exclusive code (MEC) edits—
edits for codes for services that could not have
reasonably been done during one encounter

• Medically unlikely edits (MUEs)—units of
service edits used to lower the Medicare fee-for-
service paid claims error rate
9.4 Modifiers 9-13
• Modifier—number appended to a code to report
particular facts
– Communicates special circumstances involved with
procedures.
– Tells the health plan that the physician considers the
procedure to have been altered in some way.

– There are both CPT and HCPCS modifiers.
• CCI modifier indicator—number showing
whether the use of a modifier can bypass a CCI
edit
9.5 Strategies to Avoid Common
Coding/Billing Problems
9-14
• Compliance errors can result from incorrect
code selection or billing practices.
• Strategies for compliance include:

– carefully defining bundled codes and knowing global
periods,
– using modifiers appropriately, and
– following the practice’s compliance plan, especially
the guidelines about physician queries.
9.5 Strategies to Avoid Common
Coding/Billing Problems (Continued)
9-15
• Place of service (POS) code—designates
location where medical services were provided
• Query—request for more information from a

provider
9.6 Posting Charges in Medisoft
Network Professional
9-16
• Process of posting charges differs when using a
paper encounter form versus an EHR.
• Posting charges from a paper encounter form:
– Click the New button in the Transaction Entry dialog
box.
– Complete the required fields.

– Apply the payment in the Charges Area of the
Transaction Entry dialog box.
– Save the charges using the Save Transactions
button.
• MultiLink codes—groups of procedure code
entries that relate to a single activity
9.6 Posting Charges in Medisoft
Network Professional (Continued)
9-17
• Posting charges from an EHR:
– Transactions from an EHR do not need to be

manually posted in the Transaction Entry dialog box.
– After electronic encounter form data is reviewed and
edited (if necessary), it is posted and automatically
appears in the Transaction Entry dialog box.
– Unprocessed transactions can be posted from the
Unprocessed Charges dialog box or from the
Unprocessed Transactions Edit dialog box.
9.7 Posting Patient Time-of-Service
Payments
9-18

• Practices routinely collect payment for the
following types of charges at the time of service:
– Previous balances
– Copayments or coinsurance
– Noncovered or overlimit fees
– Charges of nonparticipating providers
– Charges for self-pay patients
– Deductibles for patients with consumer-driven health
plans (CDHPs)
9.7 Posting Patient Time-of-Service

Payments (Continued)
9-19
• Accept assignment—participating physician’s
agreement to accept allowed charge as full
payment
• Self-pay patients—patients with no medical
insurance
• Real-time claim adjudication (RTCA)—
process used to contact health plans
electronically to determine visit charges
9.8 Creating Walkout Receipts 9-20

• Walkout receipt—report that lists the
diagnoses, services provided, fees, and
payments received and due after an encounter
• To create a walkout receipt in MCPR:
– Click the Print Receipt button in the Transaction Entry
dialog box; the Open Report window appears.
– Click the OK button; the Print Report Where? Dialog
box is displayed.
– Make a selection, and click the Start button.
– Click the OK button to send the report to its
destination.

9.9 Printing Patient Education Materials 9-21
• It may be appropriate to give patients education
materials during checkout in order to:
– help patients better understand their diagnoses and
treatments, and
– provide instructions following an office procedure.
• The patient education feature of MCPR provides
a built-in set of patient education articles that
can be printed and given to patients.
CHAPTER

10
Claim Management
© 2012 The McGraw-Hill Companies, Inc. All rights reserved.
Learning Outcomes
10.1 Briefly compare the CMS-1500 paper claim and the
837 electronic claim.
10.2 Discuss the information contained in the Claim
Management dialog box.
10.3 Explain the process of creating claims.

10.4 Describe how to locate a specific claim.
10.5 Discuss the purpose of reviewing and editing claims.
10.6 Analyze the methods used to submit electronic
claims.
10-2
Learning Outcomes (Continued)
10.7 List the steps required to submit electronic claims.
10.8 Describe how to add attachments to electronic
claims.
10.9 Explain the claim determination process used by

health plans.
10.10 Discuss the use of the PM/EHR to monitor claims.
10-3
Key Terms
• adjudication
• aging
• claim status category
codes
• claim status codes
• claim turnaround time

• CMS-1500 (08/05) claim
• companion guide
• crossover claim
• data elements
• determination
10-4
• development
• filter
• HIPAA X12 837 Health
Care Claim
• HIPAA X12 276/277
Health Care Claim
Status Inquiry/Response

• insurance aging report
• medical necessity denial
• National Uniform Claim
Committee (NUCC)
• navigator buttons
Key Terms (Continued)
• pending
• prompt payment laws
• suspended
• timely filing

10-5
10.1 Introduction to Health Care Claims 10-6
• Timely filing—health plan’s rules specifying the
number of days after the date of service that the
practice has to file the claim
• HIPAA X12 837 Health Care Claim—HIPAA
standard format for electronic transmission of
the claim to a health plan
• CMS-1500 (08/05) claim—mandated paper
insurance claim form
• National Uniform Claim Committee (NUCC)—

organization responsible for claim content
10.1 Introduction to Health Care Claims
(Continued)
10-7
• Data element—smallest unit of information in a
HIPAA transaction
• Notable features of the HIPAA 837 transaction
(as compared to the CMS-1500 paper form):
– It has many more data elements, though many are
conditional and apply to particular specialties only.
– It uses some different terms, and a few additional

information items must be relayed to the payer.
– It requires a claim filing indicator code.
10.2 Claim Management in Medisoft
10-8
• Insurance claims are created, edited, and
submitted for payment within the Claim
Management area of MNP.
• Information contained in the Claim Management
dialog box:
– All claims that have already been created

– Status of existing claims
– Options for editing, creating, printing/sending,
reprinting, and deleting claims
• Navigator buttons—buttons that simplify the
task of moving from one entry to another
10.3 Creating Claims 10-9
• Claims are created in the Create Claims dialog
box of MNP; to create a claim:
– Click the Create Claims button in the Claim
Management dialog box; the Create Claims dialog

box will open.
– Apply the appropriate filters; any box that is not filled
in will default to include all data.
– Click the Create button to create the claims.
• Filter—condition that data must meet to be
selected
10.4 Locating Claims 10-10
To locate a claim in MNP:
– Click the List Only… button in the Claim Management
dialog box; the List Only Claims That Match dialog
box will be displayed.

– Apply the appropriate filters.
– Click the Apply button.
– The Claim Management dialog box is displayed,
listing only the claims that match the criteria that were
selected.
– Claims can now be edited, printed, or transmitted
from the Claim Management dialog box.
10.5 Reviewing Claims 10-11
• Claims should be checked before transmission.
• Most PM/EHRs provide a way for billing

specialists to review claims for accuracy.
– In MNP, this task is accomplished by using the Edit
button in the Claim Management dialog box to load
the Claim dialog box.
• The more problems that can be spotted and
solved before claims are sent to carriers, the
sooner the practice will receive payment.
10.6 Methods of Claim Submission 10-12
• Three most common methods of transmitting
electronic claims:
– Direct transmission to the payer—Claims created in

the PM/EHR are sent to the payer’s computer directly
via a connection.
– Direct data entry—A member of the provider’s staff
manually enters claims into an application on the
payer’s website.
– Transmission through a clearinghouse—Practices
send their claims to clearinghouses to be edited and
then sent to the payer; this is the method used by
most providers.
10.6 Methods of Claim Submission

(Continued)
10-13
• Companion guide—guide published by a payer
that lists its own set of claim edits and formatting
conventions
• Crossover claim—claim billed to Medicare and
then submitted to Medicaid
10.7 Submitting Claims in Medisoft
10-14
To submit electronic claims in MNP:
– Select Revenue Management > Revenue

Management… on the Activities menu; the Revenue
Management window opens.
– Select Claims on the Process menu.
– Select an EDI receiver.
– To perform an edit check, click Check Claims; when
complete, the Edit Status column displays the status
of each claim.
– To continue with ready-to-send claims, select Send,
select Claims, and select the EDI receiver.
10.7 Submitting Claims in Medisoft

Network Professional (Continued)
10-15
To submit electronic claims in MNP (continued):
– A claim file is created and a preview report is
displayed.
– If any errors are identified, the claims must be edited
before they can be transmitted.
– Click the Send button to send the claim files.
10.8 Sending Electronic Claim
Attachments
10-16
• Attachments that accompany electronically

transmitted claims must be referred to in the
claim.
• In MNP, the EDI Report Area within the
Diagnosis tab of the Case dialog box is used to
indicate that there is an attachment and how it
will be transmitted.
– An attachment control number is required if the
transmission code is anything other than AA.
10.9 Claim Adjudication 10-17
• Adjudication—series of steps that determine

whether a claim should be paid
– Initial processing—Data elements are checked by the
payer’s front-end claims processing systems.
– Automated review—Payers’ computer systems apply
edits that reflect their payment policies.
– Manual review—Claims with problems are set aside
for further review.
– Determination—Payer makes a decision about how to
handle a claim.
– Payment—If due, payment is sent to the provider.
10.9 Claim Adjudication (Continued) 10-18

• Suspended—claim status when the payer is
developing the claim
• Development—process of gathering information
to adjudicate a claim
• Determination—payer’s decision about the
benefits due for a claim
• Medical necessity denial—refusal by a plan to
pay for a procedure that does not meet its
medical necessity criteria
10.10 Monitoring Claim Status 10-19

• Practices closely track their accounts receivable
using their PM/EHR.
• After claims have been accepted for processing
by payers, their status is monitored using the
PM/EHR.
• Monitoring claims during adjudication requires
two types of information:
– The amount of time the payer is allowed to take to
respond to the claim
– How long the claim has been in process
10.10 Monitoring Claim Status

(Continued)
10-20
• Prompt payment laws—state laws that
mandate a time period within which clean claims
must be paid
• Claim turnaround time—time period in which a
health plan must process a claim
• Aging—classification of accounts receivable by
length of time
• Insurance aging report—report that lists how
long a payer has taken to respond to insurance
claims

10.10 Monitoring Claim Status
(Continued)
10-21
• HIPAA X12 276/277 Health Care Claim Status
Inquiry/Response—electronic format used to
ask payers about claims
• Claim status category codes—used to report
the status group for a claim
• Pending—claim status in which the payer is
waiting for information before making a payment
decision
• Claim status codes—used to provide a detailed

answer to a claim status inquiry

West Consulting Network Design SummaryNTC320 v31West Consul.docx

Recommended

Recommended

More Related Content

Similar to West Consulting Network Design SummaryNTC320 v31West Consul.docx

Similar to West Consulting Network Design SummaryNTC320 v31West Consul.docx (20)

More from helzerpatrina

More from helzerpatrina (20)

Recently uploaded

Recently uploaded (20)

West Consulting Network Design SummaryNTC320 v31West Consul.docx