EE 567ProjectDue Tuesday, December 3, 2019 at 640 p.m..docx

EE 567
Project
Due Tuesday, December 3, 2019 at 6:40 p.m.
Work all 3 Parts.
Instructions.
Your project should be typed on one side of the paper only and
stapled
in the upper left hand corner. You should include a cover page
and an
appendix where you include your Matlab code. Do not place
your project
inside any kind of binder. This is to be an individual effort. You
may consult
any written material (hard or soft copy) but you may not solicit
input from
any person except that you may ask the professor or TA
questions regard-
ing your project. Your project report should be self-contained,
that is, the
reader should be able to understand the problems and your
solutions without
consulting the actual project assignment.
Part 1.
Assume we have downconverted a received signal via a mixing
operation
and now we wish to apply a LPF. One way to implement a LPF

is simply to
compute an average. In continuous time we would just integrate
the signal
since dividing by the integration time T to compute the average
would not
affect the performance since the noise would be scaled by the
same amount
as the signal component. In discrete time we would implement a
sum instead
of an integral. For this part we will assume we have a discrete
time signal
but we will compute an average instead of just a sum.
So let us assume the input to the LPF is a signal of the form
s(k) =
√
E + double frequency terms + n(k), k = 0, 1, . . .
where we have assumed scaling so that n(k) is a standard
normal random
variable for each k and ni is independent of nj for i 6= j, i, j =
0, 1, . . ..
We may ignore the double frequency terms and assume they are
suppressed,
either completely or at least sufficiently, by the LPF. The
output of the LPF
1
is
y(n) =

1
N
n
∑
k=n−N +1
s(k), n = 0, 1 . . .
where we take y(n) = 0 for n < 0.
Even though we are computing an average we will refer to this
type of filter
as an integrate and dump or I&D filter.
Now for implementation purposes we can also construct a LPF
using an
IIR filter. Let
ỹ(n) = (1 − α)s(n) + αỹ(n − 1), n = 0, 1 . . .
where we take ỹ(−1) = 0.
a. Determine (analytically) the value of α = α(N ) so that the
mean and
variance of the IIR filter output matches the mean and variance
of the
I&D filter output as n → ∞. For this task you may assume
without
loss of generality that you only have noise present.
b. Compute (analytically) the impulse response of the I&D
filter.

c. Compute (analytically) the step response of the I&D filter.
d. Compute (analytically) the impulse response of the IIR filter
using the
value of α found in part (a).
e. Compute (analytically) the step response of the IIR filter
using the
value of α found in part (a).
f. Plot the impulse response for each filter on the same graph
using N = 8.
g. Plot the step response for each filter on the same graph using
N = 8.
Part 2.
Assume we have downconverted a BPSK signal such that the
input to a
LPF is of the form
s(k) = A + double frequency terms + n(k)
2
where A is a constant and n(k), k = 0, 1, . . . are independent
zero-mean
normal random variables with variance σ2. We may ignore the
double fre-
quency terms and assume they are suppressed, either completely
or at least
sufficiently, by the LPF. Suppose the LPF is an integrator of the
form

y =
1
N
N−1
∑
k=0
s(k).
After applying this LPF the output y is a test statistic with bit-
energy-to-
noise ratio Eb/N0. We know that for BPSK the probability that
we make a
wrong decision using this test statistic is
Pb = Q
(
√
2Eb
N0
)
.
We can approximate this LPF operation using an IIR filter of
the form
ỹ(n) = (1 − α)s(n) + αỹ(n − 1), n = 0, 1 . . . N − 1

where we take ỹ(−1) = 0.
a. Using Matlab simulate the signal s(k) and the LPF operation
producing
y above for N = 8 and plot your simulated bit error rate vs.
Eb/N0 on
the same graph as Pb vs. Eb/N0 to compare. Your Eb/N0 range
should
be large enough so that the BER ranges from 0.5 to 10−6.
b. Using Matlab simulate the signal s(k) and the IIR filter
operation pro-
ducing ỹ(n) above for N = 8 and plot your simulated bit error
rate
vs. Eb/N0 on the same graph as the simulated bit error rate for y
to
compare. You should use the value of α that you found in Part 1
of this
project. Your Eb/N0 range should be large enough so that the
BER
ranges from 0.5 to 10−6.
c. The value of α that you just used does not necessarily
minimize the
probability of bit error for the IIR filter approach. Using Matlab
and
some trial and error find the value of α that does minimize the
proba-
bility of bit error for Eb/N0 = 7 dB. Using this new α (if it is
different
than that found in Part 1), plot your simulated bit error rate vs.
Eb/N0
on the same graph as the simulated bit error rate for y and the
simu-
lated bit error for the α found in Part 1 to compare. Your Eb/N0

range
should be large enough so that the BER ranges from 0.5 to
10−6.
3
Part 3.
In this part we are going to investigate the detection of signals
in noise.
We will consider both integration detection and M of N logic
detection.
Suppose we receive a signal of the form
r(t) = A cos(2πfct + φ) + n(t), 0 ≤ t ≤ T
where A is a constant over T seconds taking on the value of A =
1 or A = 0
where in the latter case we have only noise present, fc = 1 MHz,
T = 1 msec
and n(t) is a Gaussian random variable at time t with mean 0
and variance
σ2.
a. Simulate the direct integration approach to signal detection
using the
square law detector as covered in class (this detector yielded a
chi-
square random variable with 2 degrees of freedom). Assume
there is
no post detection integration. In your sims use a threshold
required
for a probability of false alarm of 10−4. You should find this

threshold
analytically. You can assume that just prior to squaring and
adding
the downconverted and filtered (integrated over T seconds)
received
waveform has the form (after scaling)
r1(T ) = A cos(φ) + n1
in the upper path of the circuit and
r2(T ) = A sin(φ) + n2
in the lower path of the circuit, where, n1 and n2 are
independent
Gaussian random variables with mean 0 and variance σ2. The
output
of the detector is then
z(T ) = r2
1
+ r2
2
.
Plot probability of detection results for SNR ranging from 0 to
15 dB.
The y-axis of your plot should use a log scale and your x-axis
should
be in dB.
4

b. Repeat part (a) but now assume we also include a post
detector inte-
grator of length N = 16. Now our overall probability of false
alarm
after post detection integration is 10−4 so a new threshold will
need to
be found. You may find the new threshold to control false
alarms via
simulation or numerically evaluating the appropriate integrals.
c. Repeat part (b) but now assume the post detecting integration
is re-
placed with an M of N logic detector where N = 16 and M = 8.
Our
overall probability of false alarm after the M of N logic is still
10−4.
You will need to find a new threshold to use here right before
the M of
N logic.
5
CHAPTER
© 2012 The McGraw-Hill Companies, Inc. All rights
reserved.McGraw-Hill
10
Claim Management
© 2012 The McGraw-Hill Companies, Inc. All rights reserved.

Learning Outcomes
When you finish this chapter, you will be able to:
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
Network Professional
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
CHAPTER
9
Checkout Procedures
Learning Outcomes
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
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.

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