Solomon Garber BPL 5100 - Prof. LaManna - Individual Case Study Case# 275 Interboro, once a small manufacturer of scalpels and other surgical equipment, became the world’s best-known maker of prosthetic limbs and surgical implants under the leadership of Jack Dodson. The structure of the company, under Dodson, was very unique. As CEO, Dodson would routinely conceive new product ideas, go directly to his R&D department and see the product through from inception to completion. In the following case study analyses, I will analyze what went wrong with Interboro, as well as advise Ms. Francesca Fortas on the appropriate direction to take the company as she takes over from Mr. Dodson.…
Procedure to Procedure edit 50010/0213T indicated Misuse of column two codes with column one code meaning 50010 in column 1 is the code that should be bill and is payable. 0213T located in column 2 of the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) code table. The main reason beyond the implementation of the NCCI is to prevent improper payment in other words to prevent physicians, non-physician practitioners, and Ambulatory Surgery Centers from billing twice for one service or combining service that should not be billed at the same time on a patient CPT Code 50010 is used for Surgical Procedures on the Kidney while 0213T CPT Code. Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves…
CCIB Intake received a SOC 341 regarding resident Susan Rehm DOB: 7/13/43. The reporting party was facility administrator Marlene Bremer who stated a caregiver named Rita responded to a pendant call at 42:42AM from the resident. When the caregiver arrived to the resident's room #522 she was described as crouch and rude. The resident was "plopped in her wheelchair. Subsequently the resident contacted "911" and paramedics along with the Police Department responded to the call.…
CCIB Intake received a SOC 341 from reporting party Donna Meekins Kaiser Home Health Social Worker/Case Manager (626) 826-6993. The reporting party stated that resident Louis Morales DOB: 8/26/46 has dementia with behavioral disturbance and resides in the facility where he has easy access to leaving the facility. The reporting party stated the resident is a health and safety hazard to himself. Subsequently there are no safety locks to prevent the resident from leaving the…
CCIB received SOC 341 from Program Director Sina Akai regarding client Harmoni King DOB: 7/3/89. On 5/23/16 Harmoni stated that her neck was hurting to the program director and the bus driver as she exited the bus. Harmoni did not attend the program on 5/24/16 and on 5/25/16 Officer Tanaka with the police department arrived at the facility at approximately 2PM and spoke with staff member Darlene Young. According to the director Harmoni's mother (name not provided) contacted the police stating that Darlene had choked Harmoni.…
The highlighted language is a broad and material exception to the operation of Section 2.6. SelectCare is prohibited from denying a medically necessary claim under circumstances where good cause existed for the lack of prior authorization. This exception prevents SelectCare from unreasonably shifting the costs of its member’s medically necessary services to the Hospitals when the Hospital is not at fault. As discussed more fully below, good cause existed for the lack of authorization on each of the claims at issue. Accordingly, SelectCare’s denial of these medically necessary claims was unreasonable and payment should be made to the Hospitals.…
Blue Cross and Blue Shield of Illinois provides a grace period to all Qualified Health Plan members who do not receive an Advance Premium Tax Credit. This grace period, during which the member is treated as active, is 31 days. At 32 days past due, the member's policy is terminated effective to the paid to date. After termination, there is a 29 day lapse period in which the member can pay the full premium due and be reinstated with no gap in coverage. At the end of the lapse period (61 days past due), the member loses the ability to reinstate and must wait until Open Enrollment or be eligible for a Special Enrollment Period for new coverage.…
FinCEN Data Management and Investigations within the Financial Crimes Task Force In 2009, The Internal Revenue Service – Criminal Investigations Division (IRS-CI) developed a model for regional task forces. The initiative created the Suspicious Activity Report Review Team (SAR-RT) task force program. The task forces were designed to review FinCEN data for case generation within the task force, and to refer potential case leads to other law enforcement organizations within the particular region. The Phoenix, Arizona IRS-CI office formed the Suspicious Activity Border Related (SABR) task force under the SAR-RT initiative in 2010.…
CCIB Intake received referral #0648-5155-9922-0085144 from reporting party (RP) Bessy Carranza, Night Intervention Coordinator with the facility . According to the RP staff member Doe heard "groaning" sound coming from child Anastacia Elizabeth Presley's, which is room #4. As the staff member entered the room, Anastacia was observed lying on bed with no pants or underwear, holding a sex toy in her vagina. In addition as the staff member looked around the bedroom, minor child Vineisha Horsley was sulking behind the bedroom door. Initially the Vineisha denied being in the room and refused to come from behind the door.…
During Susan’s time, the OT found out what Susan can do versus what she is unable to do. The OT is trying to help Susan maintain and preserve her performance abilities that she had previously. Susan is a homemaker and is very precise with her home. The OT can do this by providing ongoing services to ensure she keeps her current occupational performance. Susan can take care of her personal hygiene, toileting, cleaning, and functional mobility.…
Personal Information G.B. is a 74-year-old male that endured a left hemisphere cerebrovascular accident (CVA) after his involvement in a vehicular accident on his way to visit his daughter. The CVA resulted in a diagnosis of severe Broca’s aphasia. It has been seven months since the stroke occurred and G.B.’s symptoms have evolved. Medical Background G.B. suffered a stroke caused by damage to the left inferior frontal gyrus. The location of the damage resulted in the right hemiplegia which G.B. presents with.…
Hi Barb, Per our conversation, Dr. Daniel E. Schweid has been terminated and expressed some concerns related to his termination. He provided me with his home telephone number where can be reached after hours (preferably after 6 p.m.) 440-338-4816. He can also be reached at Murtis Taylor at 216-283-4400 ext. 6210, although he provided me with an extension; he was unsure if it was correct. Thanks for your help.…
Better Business Bureau is the non profit organization who serves as an intermediary between consumers and businesses. They should determine that the business meet BBB Accreditation Standards. Some of the systems that are put in place by the Better Business Bureau to protect businesses and consumers are as follows 1. Company should establish and maintain a positive goodwill in the marketplace. 2.…
“Summarise and evaluate the two papers. What are the implications of this work for Buss et al. (1992)?” This essay aims to further investigate sex differences in jealousy, using Buss et al’s 1992 study as a reference. Evaluating evolutionary psychology and using related supporting and critiquing research to consider a more reasoned analysis in response to the original theory and will subsequently lead to increased understanding and potential aid in scenarios regarding romantic infidelity such as therapy, which is known to be found difficult due to not yet being understood to the extent required.…
1. The key audiences in the Blue Bell crisis plan are: - Families - Older adults - Young adults - Children - Ice cream fanatics - Blue Bell enthusiasts - Stock holders - Investors 2. After careful examination of the Blue Bell press releases, their social media and press conferences, the continuing theme of the organization focused on a few key points for its target audience. Those key points Blue Bell focused on included: - Finding the root cause of the listeria contamination that were found in some of Blue Bell’s ice creams.…