The claim was billed with the diagnosis codes 724.2, 722.52, 724.4, and 724.02, which were not one of the recognized diagnoses prescribed in the LCD 30155. The beneficiary was a 65 year old man who complained of lower back pain for one year that was getting progressively worse. He received injections for pain control 10 years before the date of service; he received physical therapy recently that caused him severe pain. He underwent lower back surgery (posterior lumbar interbody fusion [PLIF]) on 03/07/2014. He was taking medications for pain and reported weakness on the left leg; he ambulated with a cane.…
Case Analysis: Clackamas Gastroenterology Associates, P.C. v. Wells Christi Wall Regis University Case Analysis: Clackamas Gastroenterology Associates, P.C. v. Wells The 2003 discrimination dispute between Clackamas Gastroenterology Associates and Deborah Wells sparked an important debate surrounding the relationships between an employer and its employees. The case provides critical guidelines for businesses today regarding employment relationships and what constitutes an “employee”, as well as guidelines for legal obligations under federal antidiscrimination laws. STATEMENT OF FACTS Deborah Wells, a disabled bookkeeper, worked 11 years for Clackamas Gastroenterology Associates, P.C., an Oregon medical clinic with 14 employees and four physicians who owned the professional corporation and made up its board of directors (Crispin, 2003, p. 1). When the company terminated her, she filed suit under the claim that Clackamas Gastroenterology violated the Americans with Disabilities Act of 1990 (ADA) (Crispin, 2003, p. 1).…
1098 claims were originally processed for Waverly Health Ctr under the wrong ID#. This caused the claims to pay $9.77 for code T1015. Those claims are currently being reprocessed for the correct payment of $ 223.97. The claims have an ETA completion date of 12/16. Furthermore, a fix is also being put in the system to ensure that future claim don’t have this issue.…
ISSUE The file contains conflicting dates regarding the claimant’s date last worked at the SGA level. The conflict needs to be resolved to determine the correct onset date. This 60- year old claimant is filing a DI only claim alleging disability due to a fractured back, sharp numbing pain, limited mobility, restricted range of motion, daily headaches, chest pain, high blood pressure, high cholesterol, dizziness, difficulty balancing, anxiety, and sleep apnea.…
Claimant Maria Guadalupe Ramirez is a full-time Pantry Cold Food Packer at the Insureds main production plant, where the company prepares in-flight food and beverage services to various major carriers. The claimant’s two Supervisors, Mr. Chea Choe and Ms. Maria Ramirez found the claimant to be one of their “best Food Packers in the Food and Pantry Department,” where the claimant has been assigned to since her date of hire on 11-18-2011. They claim the claimant has not had any medical issues or concerns throughout her employment as they have not received any medical work status reports or doctor slips involving any non-occupational or occupational related injuries or illnesses, until 12-17-15. Ms. Ramirez alleged on 12-17-15 reported for work…
This category of claims involves the hospitals obtaining authorization for one procedure at a higher level of care, but then billing for a lower level of care. SelectCare denied the claims for a purported lack of authorization. However, in these claims, the procedure performed was substantially similar to the procedure that was authorized.…
The ideal job to obtain after finishing college is a Clinical Dietician or Nutrition Consultant. This position will be obtained by education, experience and hard work. Dietary consultants can be employed independently or by health care organizations depending on career goals. From an ethical standpoint, the field of nutrition is focused on bettering and empowering individuals to live healthier, more productive lives. Business ethics means being honest, doing no harm and putting personal interests and goals behind those of the organization being supported (Collins, n.d.), by collaboratively working with patients, clients and supporting staff, this goal is obtained.…
However, the complaint will be entered into WAFERS by MPI staff for tracking purposes and processed through the same review as other WAFERS complaints. Complaints may also come through a Provider-Self Report Protocol. This is when a provider has self-discovered evidence of an overpayment by a health and human services program due to a mistake or potential fraud by a provider may submit a self-investigative report. Complaints are researched for opening a case and for the priority level based on predetermined criteria. Intake bases priority of case pursuit on the completeness of information initially provided in the complaint.…
The liver which is the largest organ in the body produces bile and stores glucose. Likewise, the pancreas produces pancreatic juices which contain sodium bicarbonate (NaHCO3) and digestive enzymes for all types of food. The gallbladder, on the other hand, is a storage for bile that is produced by the liver. This information can be found on pages 649-651. These answers are correct because the bile produced by the liver emulsifies fat and blood glucose remains constant.…
Novant health UVA, Haymarket campus is a 501 c 3 non-profit organization with a 60-bed community hospital. The center is located in the Northern Virginia Region in the city of Haymarket. The Haymarket community and other surrounding communities depend on the center for their healthcare needs. Its mission is to improve the health of communities, one person at a time and its vision is the deliver the most remarkable patient experience, in every dimension, every time. The center target population includes individuals from the city of Manassas, Gainesville and Haymarket of all ages with wide range of health issues.…
Policies within an organization guide best practice for individual roles and responsibilities in addition to patient rules and responsibilities. State and Federal policies influence organizational policies. ABC Medical Center has an influence on patients on a micro level with policies they have in place. ABC Medical Centers Human Resources link available to employees allows for access to organizational policies.…
history of the different claims that it had submitted, but WellCare upheld its denial for timely filing. WellCare’s denial of this claim is in error because the claim was timely filed with WellCare following the Hospital’s receipt of ELCO’s payment. The WellCare provider manual requires a provider to submit a claim to WellCare within 180 calendar days from the date of discharge or inpatient services.…
Normal pathophysiology of gastric acid stimulation and production. Normally the stomach holds around 50cc of fluid. There are several stimuli that work together in the complex process of the digestion process (Huether & McCance, 2012). There are three phases of gastric secretion, first being the cephalic phase, which is stimulated by the thoughts , smells and taste of food.…
CONCEPT 7: THE SIGNIFICANCE OF NURSING HISTORY AS PART OF GASTROINTESTINAL TRACT ASSESSMENT. This concept is taken from Block 4, Module 8 which is entitled as ‘Assessment of gastrointestinal system’. The digestive system is made up of organs that function together to transform food substances to energy and nutrients that are needed in the body.…
Gastrointestinal cancer refers to cancers that typically affect the digestive system. This incorporates cancers of the oesophagus, gallbladder, liver, pancreas, stomach, small intestine, bowel, and anus (GI Cancer Institute, 2012). The types of Gastrointestinal cancer can be in the upper digestive tract or the lower digestive tract. Cancers in the upper digestive tract are: Esophageal, Stomach, pancreatic, liver,gall bladder. Cancer of the lower digestive tract include: anal, and colorectal cancer.…