The CMS 1500 and the UB04 are two types of claims forms used to submit charges for reimbursement. The UB04 (also called CMS 1450) is mainly used for facility claims, such as hospitals, surgery centers, and nursing homes. They cover both inpatient and outpatient charges, along with any associated with diagnostics, supplies, and lab work. This forms shows the “resources used” by the facility. When this form is submitted electronically, it is called the 837-I, with the “I” standing for Institutional.…
HeLa cells are an immortal cell culture line that have been used to help develop the polio vaccine, understand the effects of radiation, cancer, viruses, and helped lead to advances in cloning and gene mapping. These cells came from one terminally ill woman, Henrietta Lack, who didn’t even know they had been taken from her until she was on her death bed. The author, Rebecca Skloot details the origin and use of the HeLa cell line in her book, “The Immortal Life of Henrietta lacks”. Henrietta was a black woman with a little more than that of an elementary education. She had never even taken a science class, so when she had to get treatment for her aggressive cancer she was lost, because she couldn’t understand the details of what the doctors…
Shadowing Ms. Jennifer Dreher, Clinical Nurse Specialist (CNS) and Patient Educator at Bethesda North Hospital, provided insight on her daily tasks and the profession. Ms. Dreher works in the Orthopedics department where she is actively involved in several meetings and performs coordination of care for numerous patients. She is also training Mrs. Laura Moffat, a floor nurse at the hospital studying to become a CNS. During my shadowing experience, I attended two meetings and accompanied Ms. Dreher on rounds to patient rooms.…
Without a doubt, Alan has his homework cut out for him. Before making a concrete decision on whether to offer benefits to part-time workers. He must consider that part-time employees are likely to be less satisfied with the number of working hours, benefits and schedule hours than their full-time colleagues (Sobaih, Coleman, Ritchie, & Jones, 2011). Alan must come up with a solution that interest both the employees and the company. Alan should deal with these three factors.…
Physician Manipulation of Reimbursement Rules for Patients Between a Rock and a Hard Place Matthew Wynia, Deborah Cummins, Jonathan Van Geest, Ira Wilson American Medical Association Synopsis and Summary A study was done to determine at what rate physicians manipulate the rules of reimbursement in order for patients to receive services for which they may not otherwise be granted under utilization review rules though the physician may find the service necessary. The 1998 study was a random study that contained a national sample of 1124 physicians who were surveyed through mailings and the response rate was 64%. Three areas of concentration were involved that asked if the physician’s (1) exaggerated the severity…
This policy analysis of the Patient Protection and Affordable Care Act (hereinafter referred as PPACA) begins by identifying major stakeholders and political implications. Next, it explores PPACA as health policy and reveals new possibilities of strengths, weaknesses, opportunities and threats. The issues of ethics, personal privacy, and personal rights are discussed before a brief ‘lessons learned’ review of historical health policies. Finally, this paper closes with a health policy analysis of PPACA –advantages, problems, and implications.…
TC: This Agent spoke with Ms. Angelica Latta concerning the restitution. It was explained that the Subject paid restitution in full to his Attorney, Mr. John Rouse and the payment in the amount of $1908.37 has been placed in escrow account, at this time. Ms. Latta advised that she does not feel safe collecting a check from the Subject’s Attorney and wants the money to be paid through Parole and Probation as the Court ordered. This Agent agreed and will contact the Subject, in reference to this matter.…
Issues surrounding APN regulation include numerous titles and roles that confuse policymakers who determine reimbursement; state discrepancies in scope of practice and licensing criteria, creating hardships for prescriptive authority and reimbursement across state lines; and variation in composition of regulatory boards, ranging from pharmacy to medicine, among different states.9 Unfortunately, these challenges result in restricted scope of practice for NPs, limiting their ability to practice to the full extent of their education. For example, in California, collaborative agreements defining the parameters in which the APRN can perform delegated medical acts – disease diagnosis, treatment management, and medication prescription – are required for APRNs to practice. Reimbursement of APRN-provided services is another important issue that is determined by individual states. While the federal government encourages direct reimbursement of nonphysician providers, state-level discriminatory rules and regulations continue to limit APRN reimbursement.10 The ongoing debate of whether APNs should receive the same physician reimbursement as opposed to only a percentage of the physician payment is highlighted by “incident- to billing,” which decreases APRN visibility by allowing reimbursement of the full physician rate, whereas direct billing by the NP decreases reimbursement to only 85% of the physician rate.11 APNs, including future APNs like myself, must address these discrepancies and challenges by seeking influential positions within the policy-making…
In the world of healthcare there are many different bills that get passed, some for the better of the people and then some are in place to not help the people at all. With the different health care bills that we have they have to go through congress to get passed so that at the end of the day the bills will be beneficial to everyone. We as healthcare providers should know these different healthcare bills and understand them to the fullest being that they affect us on a daily basis. The healthcare bill that stands out the most is the Patient Protection and Affordable Care Act.…
Although many of us, when we hear the name Affordable Care Act (ACA) we right away think about low coverage, better access, and affordability but there’s so much more to it. Physicians are now being faced with having to provide better patient safety and quality of care. Thanks to Medicare’s Hospital Value-Based Purchasing Program (VBP), the quality of care provided to patients by hospitals is now measured through the use of quality measures and the patients’ overall satisfaction of care. Since the program was implemented, the ACA has showed significant results in the healthcare industry. For example, by improving patient safety and quality of care, adverse effects have lowered significantly.…
Managed care has been known to use incentives and restrictions on tests and procedures in an attempt to influence physician decision making and limit costs. Guidelines for care are usually distributed by professional organizations, such as the American Medical Association, for the physician to follow in treating patients. Problems arise when the managed care guidelines do not match what the physician feels is needed for their patient. Having to receive prior approval for testing could prolong diagnoses in patients and lead to frustration is the process (Feldman, Novak and Gracely, 1998). This is when the physician must serve as an advocate for the patient if they feel a line of testing or treatment is necessary.…
As you know, when you go to the doctor, you sign your rights to privacy. Which is actually patient privacy rights, the Privacy Act of 1974? Which lead into effect December 31st 1974. An Act to amend title 5, to safeguard individual privacy from the misuse of Federal records, to provide that individuals be granted access to records concerning them, which are maintained by Federal agencies, to establish a Privacy Protection Study Commission, and for other purposes.…
In order to discuss medical necessity in the current era of health information technology, we must have a comprehensive knowledge and understanding of medical necessity. Most of this article focuses on explaining medical necessity and towards the end includes some thoughts on how medical necessity relates with health information technology. The meaning of medical necessity is different for providers, physicians, courts, government/private insurers, or consumers. Medical necessity is used for managed care plans as a tool to deny or approve necessary care.…
This information may lead one to inquire why the doctor-patient relationship is so crucial. Patients are obligated to share private information with their doctors, otherwise potentially risking their health. A bond of trust forms between a patient and their doctor over time. Patients are supposed to feel comfortable in the doctor’s office. With Obamacare snatching away Americans’ preferred doctors, patients may not experience that same level of comfort with their new physician compared to with their previous one.…
Ganiats, MD, and Jennifer A. Kempster, MPhil describes the scenario in a patient’s visit to a health care provider and the use of clinical guidelines for treatment options. The authors are suggesting that it is not possible to follow the multitude of guidelines with the time constraints place upon medical care providers without opportunity costs to patients and providers. Thousands of clinical care guidelines are continually created, updated, and stored in national databases. These guidelines, based on research findings and expert opinions, are suggestions for management of specific diseases, disease groups or health risks (Theodore G. Ganiats & Jennifer A. Kempster, 2014). In an ideal world, all guidelines necessary to a patient’s health would be followed, but this requires the expenditure of care and resources, including the use of time by both the patient and provider (Theodore G. Ganiats & Jennifer A. Kempster, 2014).…