HCR 220 Entire Course NEW

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HCR 220 Complete Class
HCR 220 Week 1 Assignment Steps in the Medical
Billing Process
HCR 220 Week 1 CheckPoint Features of Health
Plans

HCR 220 Week 1 CheckPoint Payment Methods
Presentation
HCR 220 Week 2 CheckPoint Medical Records
Documentation and Billing
HCR 220 Week 2 DQ 1 And DQ 2
HCR 220 Week 3 Assignment Understanding the
Patient Intake Process
HCR 220 Week 3 CheckPoint Eligibility, Payment,
and Billing Procedures
HCR 220 Week 4 CheckPoint Determining
Diagnosis Code Categories

HCR 220 Week 5 Assignment Assigning Evaluation
and Management (EM) Codes
HCR 220 Week 5 CheckPoint Describing CPT
Coding Categories
HCR 220 Week 5 Exercise Working with CPT
Modifiers
HCR 220 Week 6 CheckPoint Applying Level II
HCPCS Modifiers
HCR 220 Week 7 Assignment Evaluating
Compliance Strategies
HCR 220 Week 7 CheckPoint Errors and
Compliance in Coding

HCR 220 Week 8 Checkpoint Complete a CMS-1500
Claim Form
HCR 220 Week 9 Capstone CheckPoint
HCR 220 Week 9 Final Project How HIPAA
Violations Affect the Medical Billing Process

Billing Process
220-Week-1-Assignment-Steps-in-the-Medical-
Billing-Process
Billing Process
Resource: Figure 1.6 on p. 17 of Medical Insurance
Write a 500 to 750 word paper that lists the
sequence of steps in the medical billing process. In

your own words, provide a 3 to 4 sentence
explanation for each step.
Your paper must be formatted according to APA
standards to be graded.
Attach in a Word Document.

Plans
220-Week-1-CheckPoint-Features-of-Health-Plans
Plans
Resource: Table 1.1 on p. 13 of Medical Insurance:
An Integrated Claims Process Approach
Write and post a 250 to 300 word response to the
following questions:

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.

Presentation
220-Week-1-CheckPoint-Payment-Methods-
Presentation
Presentation
Resources: Appendix B
Create a 4 to 5 slide PowerPoint® presentation in
which you describe, in your own words, 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 in
your presentation.
Provide your summarized information on the
slides – not in the notes, but do not overload the
slides with too much information.
Provide APA-formatted references.
Refer to the Microsoft® Help link for assistance
with questions related to PowerPoint®.

220-Week-2-CheckPoint-Medical-Records-
Documentation-and-Billing
Write a 250 to 300 word response to the following:

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

220-Week-2-DQ-1-And-DQ-2
Week 2 DQ 1
Summarize the purposes and provisions of HIPAA
in one sentence. Also, explain how HIPAA relates
to medical ethics and etiquette. What are some
possible ramifications of a health care industry

without HIPAA regulations? Refer to p. 25 of
Medical Insurance and provide examples.
Week 2 DQ 2
How do effective medical compliance plans limit
the risk of professional liability? Do you believe it
is reasonable to hold a provider liable for the
actions of his or her clerical staff? Support your
opinion with an example.

220-Week-3-Assignment-Understanding-the-
Patient-Intake-Process
Resource: Figure 3.1 on p. 75 of Medical Insurance

Write a 750 to 1,050 word essay discussing
strategies to improve patient intake efficiency not
covered in the text. Include the following
components in your essay:
Provide at least one must-have item not covered in
the text.
Provide a minimum of one reliable reference from
the University Library or the Internet

220-Week-3-CheckPoint-Eligibility-Payment-and-
Billing-Procedures
Resource: pp. 86–88 of Medical Insurance

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.

220-Week-4-CheckPoint-Determining-Diagnosis-
Code-Categories
Resource: pp. 130-135 of Medical Insurance

Post a response to the following: Determine a
diagnosis code category for the following case
studies and explain the rationale for your
selections:
A 56-year-old woman presents to the office
complaining of pronounced weakness on the right
side of her body and slurred speech for the past 18
hours. Based on the examination, the physician
orders an MRI to investigate a possible transient
ischemic attack (TIA). A 42-year-old man comes to
the office complaining of intermittent chest pain.
The physician orders an EKG to rule out a possible
cardiac event. A 23-year-old diabetic female
exhibits a non-healing wound on her left foot.

Week 4 DQ 1
Suppose you were helping a new office file clerk
who was curious about the coding process. How

would you explain appropriate use and purposes
of the Alphabetic Index and Tabular List to the file
clerk? What problems might occur if proper
coding procedures are not used? Provide examples
of problems and propose solutions.
Week 4 DQ 2
What is the main distinction between V and E
codes? How are they similar or different? What are
your suggestions to streamline the V and E coding
process? Explain your answers.

and Management (EM) Codes
220-Week-5-Assignment-Assigning-Evaluation-
and-Management-(EM)-Codes
and Management (E M) Codes
Assignment: Assigning Evaluation and
Management (E/M) Codes

Resources:Figure 5.3 on p. 161, and Table 5.4 on p.
165 of Medical Insurance
Assign appropriate E/M codes for the following
five cases:
Initial consultation performed for a 43-year-old
woman with unexplained weight loss, abdominal
pain, and rectal bleeding. A comprehensive history
and examination is performed.
A 32-year-old patient presents complaining of flu-
like symptoms characterized by unremitting
cough, sinus pain, and thick nasal discharge. An
examination reveals bronchitis and sinus
infection. The patient is prescribed a 7-day course
of Zithromax.
Established patient on Lithium presents for
routine blood work to monitor therapeutic levels
and kidney function. A nurse reviews the results
and advises the patient that tests are normal, and
no change in dosage is indicated.

A 78-year-old diabetic female presents for check-
up and dressing change of wound on left foot. An
examination reveals the wound is healing. The
nurse applied new dressing and patient will return
for a check-up in one week.
A mother brings in her 4 ½ month-old baby for a
routine wellness check. An 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 2 to 3 complete sentences
for each of the case studies.

Coding Categories
220-Week-5-CheckPoint-Describing-CPT-Coding-
Categories
Coding Categories
Resource: p. 145 of Medical Insurance

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 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 three CPT code categories?
Provide one example for each category in your
description.

Modifiers
220-Week-5-Exercise-Working-with-CPT-
Modifiers
Modifiers
Resource: Table 5.2 on p. 154 of Medical Insurance

Complete the exercise by identifying the correct
CPT modifier to its corresponding procedure for
the following:
Bilateral procedures
Multiple procedures
Prolonged evaluation and management
Unusual anesthesia
Mandated services

HCPCS Modifiers
220-Week-6-CheckPoint-Applying-Level-II-HCPCS-
Modifiers
HCPCS Modifiers
Resource: Table 6.2 on p. 195 of Medical Insurance

Apply the appropriate Level II HCPCS code
modifier for each of the following examples.
Explain your rationale for each selection. For
example, the first one would be:
Portable home oxygen unit - QM
Emergency ambulance transport and extended life
support
Diagnostic mammogram, left breast
Cortisone 10 mg injection, right shoulder
Nonelectric wheelchair
Intravenous catheter line, right arm
Laboratory certification, cytology specimens
Chest X-ray
Prosthetic hip replacement, left side
Electric hospital bed

Week 6 DQ 1
How are permanent codes different from
temporary codes? What could be the result of a
system without permanent codes? Provide
examples in your answer.

Week 6 DQ 2
Briefly explain the steps used to assign HCPCS
codes for billing purposes. Do you believe it is
more or less efficient to use different billing
procedures for Medicare, Medicaid, or private
payers? Why or why not? What are advantages and
disadvantages of having unique coding systems for
each type of insurance?

220-Week-7-Assignment-Evaluating-Compliance-
Strategies
Write a 750 to 1,050 word essay evaluating billing
and coding compliance strategies. In your essay,

provide an overview of the compliance process,
and offer your judgment either supporting or
criticizing a particular method. Make suggestions
for improvement at the end of your evaluation.
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 a minimum of one reliable reference from
the University Library or the Internet.
Your paper must be formattedaccording to APA
Attach in a Word Document.

220-Week-7-CheckPoint-Errors-and-Compliance-
in-Coding

Resource: pp. 207 & 211 of Medical Insurance, and
Medical News Today Web site
athttp://www.medicalnewstoday.com/
Review the NPR Web site
athttp://www.npr.org/templates/story/story.php
?storyId=5348863
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.

Claim Form
220-Week-8-Checkpoint-Complete-a-CMS-1500-
Claim-Form
Claim Form
Checkpoint: Complete a CMS-1500 Claim Form

Complete the CMS-1500 claim form worksheet
located in Appendix C. If you believe information
provided in the following list is insufficient to
adequately fill a required field with data, for
example, to supply a specific diagnosis code,
indicate this by typing N/A.
Name: Jane Smith
Insurer: TRICARE
Policy Number: 123456
ID number: 999000666
DOB: 01/01/1950
Gender: Female
Insured: James Smith, spouse
Address: 1111 Noname Court, Nowhere, NY 22222
Marital Status: Married
Patient’s Employer: Homemaker
Spouse’s Employer: U.S. Army
Nature of Condition: Routine exam
Patient Signature

Week 8 DQ 1
How are the data elements contained in the HIPAA
837 claim form similar to the CMS-1500, and 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 answers
Week 8 DQ 2
Why is it important to prepare a clean claim? What
suggestions might you make to ensure that
submission of a clean claim takes place? Provide
examples.

220-Week-9-Capstone-CheckPoint
Post a 250 to 300 word response in which you
explain, in your own words, how HIPAA, ICD, CPT,
and HCPCS influence each of the ten steps of the
medical billing process.

220-Week-9-Final-Project-How-HIPAA-Violations-
Affect-the-Medical-Billing-Process
Part One:

Resources:Appendix A, Appendix C, and Table 8.3
on pp. 258–259 of Medical Insurance
Refer toTable 8.3 on pp. 258–259 of your text 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: James Brown
Account Number: 080811
Insurer: Medicare
Policy Number: 1098765
ID number: 12345678910
DOB: 02/01/1940
Gender: Male
Insured: James 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 only), CPT, HCPCS, and
insurance information.
If you believe there is insufficient information
provided to fill a required field with data, indicate
this by typing N/A.

Post the completed CMS-1500 form as an
attachment.
Final Project: How HIPAA Violations Affect the
Medical Billing Process
Part Two:

Write a 1,500 to 1,750 word essay in which you
discuss implications of both forms of the patient’s
diseases, HIV and AIDS, from the perspective of
HIPAA confidentiality. Include the following in
your essay:
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 a minimum of three references from the
University Library or the Internet.
Your paper must be formattedaccording to APA

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