Jenifer: Why does location matter related to reimbursement? 

Post 2 response 

 Manuela Noel Week 2 DiscussionCOLLAPSE

1. How does the location of where a service is performed determine which code set is used? Relate issues such as reimbursement schedules, co-pay amounts, and coverage limitations.

The location of place of services should always be code accurately when it comes to different setting that services is being rendered. For example, a check at your primary care doctor will be a different code and fee than conducting a minor surgery procedure at an outpatient clinic.

1.  What is a reimbursement schedule?

Reimbursement schedule is a set of listing fee schedule used by healthcare insurance company (Medicare) to pay doctors, providers, or suppliers which is used to reimburse healthcare professionals on a fee for service basis. For example, after a patient undergo services from a doctor office or hospital the insurance company or government payers reimburse for the service that was provided.

1. What is a copay?

Copay is a fixed amount that is being covered by a patient before seeing a health care professional to rendered service. For example, a patient goes in to see their primary care doctor to conduct a physical check-up for the visit at the office the fee to see the doctor id $89.00 the insurance covers for the visit however, for the procedure that is being provided the patient will need to cover the remaining 25% of service which is the copay.

4. What type of service does the term “procedure coding” includes?
Some of the procedures includes:
– Medicine (90281 to 99607) 
– Anesthesia (00100 to 01999) 

– Radiology (70010 to 79999) 
– Evaluation and Management (99201 to 99499)
– Pathology and Laboratory (80047 to 89399) 

– Surgery (10021 to 69990) 

Aalseth, P. (2015). Medical Coding: What it is and How it Works ; Second Edition (2nd ed.). Jones and Bartlett Learning.

Comment 1

As a mental health community, outside support and resources are vital to this population. External stakeholders are important for the success of my project for many reasons. External stakeholders provide resources and information that will be essential in providing the best available treatment necessary for postpartum depressed women. A stakeholder can be defined as “a person, group or organization that has interest or concern in an organization. Stakeholders can affect or be affected by the organizations actions, objectives and policies” (Stakeholders, n.d.).  Without our patients and support, their business satisfaction and overall reputation goes down. The idea is also vice versa, without their support and business, we have no references and resources to give to our patients. Some of our stakeholders include National Alliance on Mental Health (NAMI), housing options and shelters. A lot of our resources are outpatient and long-term inpatient care. This support is important because women with postpartum depression will need continuous care after their inpatient stay. They need other community resources to draw from. These resources will help them in a crisis situation.

How we can go about securing this support is through the patient themselves. We keep referring our patients to their resources, which drives business for both companies. Also, when these patients receive exceptional care they will support the businesses and tell other patients with the same mental health problems. Another secure point would be donations. Donations always help the cause, and show our support for their business and impact. Also, promotion is another security. Promotion on how well their business is with individuals with postpartum depression. Securing these stakeholders will be key to my capstone because of all the information that I can obtain and use as research.

Comment 2

As a nurse it is my job to protect my patients and give them the best care that I can. I and other nurses and health care workers cannot achieve this without the assistance of internal and external stakeholders. According to Landau (2017), a stakeholder is either an individual, group or organization who is impacted by the outcome of a project. They have an interest in the success of the project, and can be within or outside the organization that is sponsoring the project” (para 1). Stakeholder support is vital for health care because they are the ones that provide the resources or finances for the necessary resources. They are necessary for my project because I am able to use them for information and help implement my project. For example, the DON has given me permission to use the facility and its resources to gather information. Without the approval of the DON, I would not have access to the facility and the residents. My mentor is also a stakeholder and gives me direct information about the patients and assists with my research about my project. I am able to gain more information from him and the wound care doctor that will assist the care of my patients, treat their wounds, increase their safety, and increase their overall outcome.

In order for me to be successful, I will need to gain and secure their support. I have already gained it, but I can secure it by keeping them interested in my project. The main objective of my project is increasing quality improvement regarding patient care and decreasing incidences of pressure ulcers in nursing homes. I will work with my mentor and meet with him at least once a week, so I can see and learn how he treats the patients wounds. I will try to go on the days when the wound doctor is there, so I can learn how she assesses the wounds and decides what treatment would best suit the patient. Shadowing my mentor would show him and the DON how invested I am in my project and secure their support.

Comment 3

One technological implementation process that I found to be useful for my capstone project is the PPD ACT app for your cellphone. This app is designed to help “doctors better understand the underlying biology and genetic risks of postpartum depression in order to better serve affected women” (Health Power for Minorities, 2015). The app has 2 integral parts:

            Part 1: The app asks the user questions about their experiences with childbirth, mood, and anxiety symptoms after the birth. The responses to these questions will allow the app to point the users in the right direction to doctors in the area, and who would be most effective for treatment.

            Part 2: The second part is the app will have a DNA kit mailed to the individual. The individual will then get a collection of their saliva and have it mailed back to the company. This saliva will then be analyzed and show researchers is there is any difference in women with postpartum versus non-postpartum, and develop treatments and more effective care. (Pact for the Cure, 2017).

This technology could be useful to my capstone project because If I could see the results of the DNA samples, it could provide me with more effective ways to care for postpartum women. It could show me if breastfeeding or medications help the best with postpartum depression decrease. I will be able to provide my patients with the most effective treatment and possibly stop the symptoms in future cases. This research could help stop postpartum depression entirely and give the health care professionals a heads up advantage.

Comment 4

In this modern and fast evolving era where technological advances are appearing and changing at a glance, it is not possible to progress without the implementation of the right technologies. For prevention of occurrence of urinary tract infection and to fight for its cure, the use of technology is crucial. Here, one should incorporate technologically advanced solutions to achieve project objectives. The technology implemented should be easy to use and understandable for all level of users including the nurses and the doctors. It should be available for access easily without any reliability (Parry, 2013). For measurement of this, symptoms can be mentioned on an app which can deduce to the patient if they have urinary tract infection or not. In this way, lots of the caregivers can predict and preliminary resolve problems and can accomplish EBP goal.

Another application would be to use more sensitive methods of detecting bacteria causing UTI (E. coli or Klebsiella) and crucial for UTI indicators, methods like an Accucheck machine. The writer has already seen the type of machine for PTT, and PT/INR used even 10 years ago. The complication with the UTI detection is that it uses microbiological approach for bacteria detection and requires time to grow them. Methods of molecular biology, which are also used in forensics, are useful for the application. The methods can potentially detect a single molecule of DNA in the solution, thus speeding up detection of UTI and fast streaming the process of the treatment. In case a UTI is suspected, a provider starts antibiotics immediately. Therefore, UTI is already strongly suspected even after urinalysis and C&S results are used primarily to confirm the diagnosis and which antibiotic to use.

The doctors, however, should guide the patients not to misuse the app and to not go for self-medication under the influence of the app. If they feel that anything is dangerous, they should reach out to the hospital authorities at earliest instead of relying on the app to give some lifesaving instructions. It should be made clear that the app is for daily prevention implementation purpose rather than self-medication.

U5D1
TYPE – Reflective Practitioner
All of us have been involved in various kinds of conflicts related to our work environment. Using a situation that you were involved in, describe the conflict and how it was handled.

• Was the outcome positive or negative?
• How did the involved parties feel about the resolution, did they feel that they were heard, that their issues were resolved in an appropriate manner?
• Based on what you have read in this unit, what could have been done to improve both the situation and the outcome?
• What is professional civility/incivility?
• How does this impact professional relationships an patient care outcomes? 
• What incivility literature evidence is available that supports that conflict resolution impacts work environments and patient care?

Students are expected to:

1. Post an initial substantive response of 200-250 words to 

In Saunder’s article that you have just read, he explored how some critics have characterized Phoenix as well as connect the character to other literary works. For this week’s assignment, you must summarize the article without inserting your own biases in about 150-200 words.

Having a clear understanding of what is in this article is crucial to being successful on the final exam. For the final exam, you will write a comparison/contrast essay exploring the similarities and differences of your claim about Phoenix Jackson and Saunder’s claim about Phoenix James.

What do these similarities and differences reveal about Phoenix? Did your opinion of Phoenix change? Did you see her in a new light? Did any of his evidence strengthen your claim?

In your outline for your final exam, include your thesis, topic sentences, relevant quotes from your paper (cite using your last name and page number), Saunder’s article, and Welty’s story that you intend to use.

Develop a COMPLETE learning plan, including handouts, worksheets, appropriate links, standards, objectives, content, and assessments. Ues one of the templates posted on Blackboard, or one that is used in your major area or school district.  You are required to submit a draft copy for review.  By submitting this draft you will receive 20 points. After I review this draft I will return it to you with comments and an “as is” score between 0 and 60.  This score will appear as a “placeholder” in your final score for the course.  If it is high you may wish to keep it and do nothing morte to improve your score or you may improve upon it and resubmit it for a final review.