HCR 220 Complete Course

HCR 220 Week 9 Final Project How HIPAA Violations Affect The 

Medical Billing Process 

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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 to Table 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 formatted according to APA standards to be graded. 

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HCR 220 Week 9 Capstone CheckPoint 


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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. 

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HCR 220 Week 8 DQ 2 


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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. 



HCR 220 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. 



HCR 220 Week 7 Individual Assignment Evaluating Compliance 

Strategies 



Individual-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 standards to be graded. 



HCR 220 Week 7 CheckPoint Errors And Compliance In Coding 



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 

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. 






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? 





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How are permanent codes different from temporary codes? What could 

be the result of a system without permanent codes? Provide examples in 

your answer. 



HCR 220 Week 6 CheckPoint Applying Level II HCPCS Modifiers 



CheckPoint-Applying-Level-II-HCPCS-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 


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HCR 220 Week 5 Individual Assignment Assigning Evaluation And 

Management Codes 



Individual-Assignment-Assigning-Evaluation-and-Management-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. 



HCR 220 Week 5 Exercise Working With CPT Modifiers 



Exercise-Working-with-CPT-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 



HCR 220 Week 5 CheckPoint Describing CPT Coding Categories 



CheckPoint-Describing-CPT-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.






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. 






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. 



HCR 220 Week 4 CheckPoint Determining Diagnosis Code Categories 



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-yearold 

diabetic female exhibits a non-healing wound on her left foot. 



HCR 220 Week 3 Individual Assignment Understanding The Patient 

Intake Process



Individual-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 



HCR 220 Week 3 CheckPoint Eligibility, Payment, And Billing 

Procedures 



CheckPoint-Eligibility,-Payment,-and-Billing-Procedures 

Resource: pp. 86–88 of Medical Insurance 

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. 






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. 





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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. 



HCR 220 Week 2 CheckPoint Medical Records Documentation And 

Billing 



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 



HCR 220 Week 1 Individual Assignment Steps In The Medical Billing 

Process 



Individual-Assignment-Steps-in-the-Medical-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. 

Format according to APA standards to be graded. 



HCR 220 Week 1 CheckPoint Payment Methods Presentation 



CheckPoint-Payment-Methods-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. 



HCR 220 Week 1 Checkpoint Features Of Health Plans 



Checkpoint-Features-of-Health-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. 



HCR 220 Complete Course 


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Course 

HCR 220 Week 1 Checkpoint Features of Health Plans 

HCR 220 Week 1 CheckPoint Payment Methods Presentation 

HCR 220 Week 1 Individual Assignment Steps in the Medical Billing 

Process 



HCR 220 Week 2 CheckPoint Medical Records Documentation and 

Billing 

HCR 220 Week 3 CheckPoint Eligibility, Payment, and Billing 

Procedures

HCR 220 Week 3 Individual Assignment Understanding the Patient 

Intake Process 



HCR 220 Week 4 CheckPoint Determining Diagnosis Code Categories 

HCR 220 Week 5 CheckPoint Describing CPT Coding Categories 

HCR 220 Week 5 Exercise Working with CPT Modifiers 

HCR 220 Week 5 Individual Assignment Assigning Evaluation and 

Management Codes 



HCR 220 Week 6 CheckPoint Applying Level II HCPCS Modifiers 

HCR 220 Week 7 CheckPoint Errors and Compliance in Coding 

HCR 220 Week 7 Individual Assignment Evaluating Compliance 

Strategies 



HCR 220 Week 9 Capstone CheckPoint

HCR 220 Week 9 Final Project How HIPAA Violations Affect the 

Medical Billing Process 


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HCR 220 Complete Course

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