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.

 THEORETICAL PERSPECTIVES FOR ADVANCED PRACTICE NURSING ANALYSIS /CONCEPT PAPER Analyze one of the following concepts: “Advanced Practice Nursing,” “Leadership in Nursing Practice” or “Holistic Nursing Practice” in terms of the interrelationships of philosophy, theory, research, and practice. The paper should be 7-10 pages in length (including title page & reference page). Paper should be written in APA format. Attention should be paid to proper grammar and correct spelling. RECOMMENDED OUTLINE Title Page Introduction of concept Discussion of o Philosophy o Theory o Research o Practice Analysis of concept in terms of interrelationship of philosophy, theory, research, and practice. Conclusion Reference Page Note: 1. There must be minimum of 5 References / citations. 2. The references /citations should not be older than 5 years (2015 – 2020). 3. References / citations must be written in APA Style. 4. The References / citations must be from scholarly articles / textbooks/ journals and not from blogs. 5. Wikipedia must not be used for references at all. 

APA format 1 and half pages long MSN degree 3 peer review references

 

Week 2-Main Post-Jamie Michalski

Diversity and Health Assessments

            Caring for patients in healthcare today, providers will encounter many different patient populations that come from a diverse set of cultures, lifestyles, and backgrounds that have beliefs and practices regarding health and illness which may be different from the provider. Providers must first examine their own beliefs, values, and culture for self-awareness and to examine for potential bias. Approaching individuals from a variety of cultures and backgrounds also requires flexibility and the ability to adapt the health history and physical exam to the patients’ needs or culture. Having an understanding of the patient’s beliefs, lifestyle, culture, and background and how they impact the patient is necessary for providers to provide culturally competent care.

 The patient selected for this discussion is MR, a 23-year-old male patient, complaining of anxiety.  

Identifying Information: MR is a 23-year-old Native American male seen in the office on September 5, 2018. The history is obtained from both a written questionnaire filled out before the visit and from the patient, and he is considered a reliable historian.

Chief Complaint–“I’ve been anxious lately and used both pot and alcohol to help me feel better” and is concerned about “not getting into heaven.”

History of Present Illness: a 23-year-old male patient that uses both marijuana and alcohol for anxiety symptoms. MR describes the anxiety as starting when he lost his job one month ago. MR describes the anxiety occurring on 4-5 days during the week, and MR describes it as a “feeling of fear about providing for my family,” and on 4-6 days/per week he uses alcohol and smoking “pot” to “feel better.”

Current Medications-None

Family History- Diabetes-Father, Hypertension-Mother, and Alcoholism-Father.

Social History-smokes marijuana –per patient written questionnaire: typical amount described as 1 “joint”; with use of 6-7 times per month. Drinks alcohol, described as beer; amount varies from 36-64 ounces 3-6 times per week. Occasional use of liquor; the typical amount is 3-8 ounces per week usually with beer. Smokes cigarettes with a six pack year history.

Questions to ask MR:

1. Do you use any herbs for spiritual practices?
2. What is your spiritual or religious heritage?
3. Do your beliefs help you handle stress?
4. What do you consider drugs?
5. What practices prevent admission to heaven?
6. How long have you been drinking alcohol? Smoking marijuana?
7. When did you begin feeling this way?
8. How have you been sleeping?
9. Do you have thoughts to harm yourself?
10. What worries you?
11. How are things at home? Work?
12. How would you like me to help you with your anxiety?

Native American patients may have a lower socioeconomic status with the median annual household income is $ 37,353 for Native American households compared to $ 56,565 for non-Hispanic whites (US Department of Health and Human Services [HHS], Office of Minority Health [OMH], 2018).  Patients with lower socioeconomic status may not seek medical care due to lack of insurance, ability to pay insurance premiums, have transportation issues, not fill prescription medications, or take prescribed medications sparingly with the belief to “make the medication last longer.”

Native American patients’ spirituality is also a cultural factor that requires cultural competence for the practitioner to understand how the patients’ spiritual practices influence his care and how the provider can assist the patient. The practitioner must have an understanding of the relationship between spiritual beliefs and health practices and how beliefs relate to illness, health, family, symbols, and taboos (Sullivan, 2012). The patient’s spiritual belief may include that mental health issues are viewed as spiritual punishment that is unable to be healed.

Native American patients have twice the rate of diabetes than non-Hispanic white patients (HHS, OMH, 2018). The influence of both smoking cigarettes, marijuana and a family history of diabetes and hypertension concerns for the development of diabetes and hypertension in the future.

The Native American culture has undergone a significant shift in the past 30 years. Nearly 60% of Native Americans now live in major metropolitan areas, and 22% still live on reservations (HHS, OMH, 2018). This shift from reservations to metropolitan areas has changed the Native American lifestyle and culture which strives to find harmony and live with nature (Ball, Dains, Flynn, Solomon & Stewart, 2015). Native Americans have higher rates of alcoholism, and chronic liver disease either from alcoholism, obesity, and exposure to hepatitis B and C virus is the leading cause of death (HHS, OMH, 2018).

References

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.) St. Louis, MO: Elsevier Mosby

Sullivan, D. D. (2012). Guide to clinical documentation (2nd ed.). Philadelphia, PA: F. A. Davis.

US Department of Health and Human Services, Offices of Minority Health. (2018). Profile: American Indian/Alaskan Native Profile. Retrieved from https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=62

  The Center for Medicare and Medicaid Services (CMS) publishes a list of health care-acquired conditions (HACs). What actions has your health care organization (or health care organizations in general) implemented to manage or prevent these “never events” from happening within their health care facilities? Support your response with a minimum two peer-reviewed articles.