Week 4 Assignment HM 1015 PDF

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MEDICAL TERMINOLOGY...

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HM1015: Week 4 Assignment

How will I apply what I know a about bout medical terminology to diagnostic and proce procedure dure coding on the jjob? ob? This assignment helps you apply your knowledge from this week’s module and textbook readings. As a medical office professional, you may be expected to file claims to thirdparty payers for reimbursement of services. The bulk of your claims will be submitted electronically; however, there will be circumstances that will require you to submit a paper claim. It is important that you have a good understanding of the differences between the two types of claim submission as well as when it is appropriate to submit a paper claim for payment.

25 Medical Terminology – Urinary System Answer the following questions. Chapter 9 Medical Terminology 1. Trigone is a portion of the urinary bladder. 2. What is the combining form for renal pelvis? Pyelo3. Anuria is failure of the kidneys in producing urine. 4. Select the term that is spelled correctly and give its meaning. A. meatis B. meatus A or B: B. Meatus meaning: An opening leading to the interior of the body. 5. Which term describes the dilation of one or both kidneys? ☐ nephritis ☐ nephroptosis ☒ hydronephrosis ☐ nephropyosis

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6. Which kidney structure consists of a cluster of capillaries surrounded by the Bowman's capsule?

☐ glomerulus ☐ medulla ☐ renal pelvis ☒ nephron

Medical Billing and Claim Management Answer the following questions. Chapters 9, 11 Understanding Health Insurance 7. Physician submit _____ service/procedure codes to payers. ☒ CPT/HCPCS level II ☐DSM-5 ☐ HCPCS level III ☐ ICD-10-CM

8. The reverse of the CMS-1500 claim contains special instructions for ☒ government programs. ☐ BlueCross and BlueShield. ☐ private commercial insurance. ☐ workers’ compensation. 9. Electronic claims must meet requirements adopted as the national standard under ☐ ARRA. ☐ CLIA. ☒ HIPAA. ☐ MMA. 10. Which situation requires the provider to write a letter explaining special circumstances?

☒ A patient’s inpatient stay was prolonged because of medical or psychological complications. ☐ Charges submitted to the payer are lower than the provider’s normal fee (e.g., -22 added to code). ☐ Surgery defined as an inpatient procedure was performed while the patient was in the © Ultimate Medical Academy

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hospital. ☐ Surgery typically categorized as an ASC procedure was performed in a hospital outpatient setting.

11. The optical character reader (OCR) is a device that is used to ☐ convert CMS-1500 claims. ☐ enter CMS-1500 claims. ☐ scan CMS-1500 claims. ☒ view CMS-1500 text.

12. When entering patient claims data onto the CMS-1500 claim, enter alpha characters using

☐lower case. ☐ sentence case. ☐title case. ☒ upper case. 13. The billing entity, as reported in Block 33 of the CMS-1500 claim, includes the legal business name of the ☐ acute care hospital. ☐ insurance company. ☒ medical practice. ☐patient (or spouse). 14. Identify the information provided in the form locators for each of the two major sections of the CMS-1500 claim form. a. Form blocks 1-13: Patient and Insured b. Form blocks 14-33: Provider or Supplier 15. List the three common errors that delay CMS-1500 claims processing. a. Keyboarding Errors © Ultimate Medical Academy

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b. Attachments that do not include patient and policy ID c. Omission of Information

Reflection Reflect on what you have learned this week to help you respond to the question below. You may choose to respond in writing or by recording a video!

16. Promptly submitting accurate insurance claims allows medical practices to have a continuous cash flow, which is vital to maintaining a medical practice. As a medical office professional, how can you motivate yourself to ensure that claims are submitted in a timely manner, are accurate, and complete? Honestly, my biggest motivations are people and patients. I know from personal experience that mistakes can be made when filing claims and how that can greatly prolong payment and reimbursement. By ensuring claims are submitted properly, completely, and efficiently, both the provider and patient receive their payments in a timely fashion and can therefor provide and seek future treatments.

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