Lab Assignment Avoiding Medicare Audits

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One of the recommendations for avoiding the pain of a Medicare audit is to put a plan in place to ensure that the organization is following best practices for creating and submitting claims. Read through the Five Things You Need to Know about Medicare Audits (Links to an external site.)Links to an external site. (https://www.webpt.com/blog/post/5-things-you-need-know-about-medicare-audits) article. Then imagine that you, as an HIM Professional, were asked to put together a similar plan. In a four-paragraph Word document, identify steps you would implement to minimize the chance of being subjected to a Medicare audit. Name the file “MedicareAudit” 

 
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Lab Assignment Claim Submission Differencesdescribe An Insurance Companys Process

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  1. Go to at least two of the following insurance carrier websites that lay out their claim submission guidelines. Identify at least three differences between two of the insurance carrier’s policies. In a Word document, for each item you found, write one paragraph for each of the differences. Be sure to identify the carriers. Save the Word document as “SubmissionDifferences”.
  • BCBS-IL Claim Submission Home Page (Links to an external site.)Links to an external site.
  • Anthem Claims Submission Guidelines (Links to an external site.)Links to an external site.
  • Cigna Claim Submission Guidelines (Links to an external site.)Links to an external site.

  1. Research an insurance company website, such as Aetna, BCBS, or Cigna. Find a page where it provides instructions for submitting a claim. In a Word document, describe the process in terms a non-billing professional might understand, especially special cases or exceptions. Save the document as “ClaimProcess”  

 

 
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Lab Assignment Computer Security

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 Look over the materials in this lesson(note: Medical billing/coding or Healthcare), and think about how data is collected, stored, and shared. Now, think about all the ways that a hacker might gain access to that information. Identify at least three ways (and more if you can) a hacker might gain access to information.  Enter them into a Word document, save the file with the name “ComputerSecurity “

 
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Lab Assignment Evolution Of Him

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Read the article Health Information Management 2025: Current “Health IT Revolution” Drastically Changes HIM in The Near Future (Links to an external site.) http://bok.ahima.org/doc?oid=106207#.Wt4830xFyUl. regarding how HIM may be dramatically different in years to come.

Identify three trends discussed in the article, and for each, explain how it might change inpatient billing and coding. 

 
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Lab Assignment Hospital Payment

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Download the Hospital Payment worksheet.Preview the document Then, watch the video below on how hospitals are currently reimbursed, and how the system might be improved to reduce costs and increase care. Fill out the worksheet, saving the file as “HospitalPayment” 

How Hospitals Make Money (13:58)  

 
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Lab Assignment Identity Theft

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 Look around your PC or laptop and the space in which you are accessing this course(note: this course is about Medical billing/coding or Healthcare). In a Word document, identify three ways that someone might steal personally-identifiable information from you. For each, try to think of a way to address it. Save the file as “IdentifyTheft” 

 
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Lab Assignment Insurance Plan Webquest

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Visit the website of an insurance company, such as Aetna, Blue Cross/Blue Shield, or Humana and identify one of the company’s insurance plans. In a four-paragraph paper, describe what the plan provides and what obligations it places on patients. Contrast this with another plan offered by the insurance company or by another insurance company.

Save the file as “InsuranceWebQuest” 

 
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Lab Assignment Respiratory Cleft Palate Essay

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 Lab Assignment: Respiratory Cleft Palate Essay

1. Write a 1-2 page paper about infants born with a cleft lip and palate. Be sure to answer all of the questions below:

  1. What are the different types of cleft lip and palate?
  2. What are some complications that an infant could experience with a cleft lip and palate?
  3. How is it diagnosed?
  4. What is the treatment?
  5. On average, how many surgeries will a child with a cleft lip and palate have to undergo?
  6. What is nasoalveolar molding?
  7. What two CPT codes represent repair of a nasal deformity secondary to congenital cleft lip and/or palate?

When you are finished, name your file “Cleft Palate Essay”

 
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Lab Assignment Revenue Integrity

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The idea of revenue integrity is to take steps to ensure that everything a hospital charges for is valid and billable, and that it is billing for the allowable items for a given payer and plan rather than eat the costs of those items.

Watch the following video about revenue integrity. 

Watch the Video below: 

3 Areas of Healthcare Revenue Integrity (7:09)

Write a one-page paper that summarizes at least five lessons you took from the video. 

 
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Lab Assignment Sentinel Event

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The Joint Commission 

The Joint Commission, or simply “TJC,” is an organization formed to accredit medical facilities. It is a private organization composed of physicians, nurses, pharmacists, risk managers, and other professionals. The main concern of TJC is patient safety. The Joint Commission Accreditation is voluntary. However, CMS states that, in order to receive reimbursement from Medicare and Medicaid, a health care provider must have completed the accreditation survey and be approved by The Joint Commission. Typically, TJC will visit every 18-24 months to ensure compliance.

HIM Professionals should be aware of what TJC evaluates to accredit a medical facility, because he/she may be called upon to provide needed information or otherwise assist in a TJC audit.

Suppose you worked at a medical facility and were given the assignment to prepare the facility for a Joint Commission audit. Watch the video on the TJC again, and download and view the TJC Readiness Checklist.Preview the document

What to Expect from THC Surveyor (6:59)

https://youtu.be/RIGsy0J5ydA

Assignment:

A patient came to Dr. Bayberry’s office. She was diagnosed with pneumonia. She was given an antibiotic injection. Before the injection, she was asked the appropriate questions and denied having any allergies to medications. The medical assistant had the patient wait the allowed 15 minutes, and there was no visible adverse reaction. The patient was released to go home with her daughter. Five minutes after leaving the office, the daughter came back in a panic: the patient was unconscious in the car. Dr. Bayberry and the medical assistant went to the car to find that the patient had gone into cardiac arrest. EMS was called and the doctor and medical assistant did CPR until they arrived.

According to the article about sentinel events from TJC, what takes place now? Is there a need to do any reporting? Is TJC involved? Write a four-paragraph paper on what takes place after a sentinel event such as the above occurs. Save the file as “SentinelEvent”

 
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