Primary Task Response: Within the Discussion Board area, write 400–600 words that respond to the following questions with your thoughts, ideas, and comments. This will be the foundation for future discussions by your classmates. Be substantive and clear, and use examples to reinforce your ideas.

Accurate coding and billing are essential to a health care facility and to a physician’s financial survival. Coding is a complex task that ties to charges and revenue generation. Failure to capture all charges associated with a patient encounter can result in significant revenue loss. Medical necessity also plays a vital role in the contract with the facility or physician in terms of receiving payment from the third party payer (e.g., an insurance company).

Part 1

For this Discussion Board, you will define medical necessity, and you will describe the criteria to determine it.

Part 2

Once the patient has an established diagnosis and the services and procedures have been ordered, you will code out this information and place it on the claim for payment.

It is important for health care professionals to understand this process to receive accurate reimbursement.

For this part of the discussion, you will be identifying the coding systems that are utilized to support the diagnosis, services, and procedures.

List and discuss the coding system that is utilized to code out the patient’s conditions or diagnosis. Provide an example of a diagnosis with the appropriate code as an example, and respond to the following questions:

• What is the coding system replacing the diagnostic system?
• Will it be implemented this year? Explain your answer.

Next, identify what coding system is utilized to capture the services and procedures that the patient has received (both levels). List an example of a service or procedure with the appropriate code as an example, and respond to the following questions:

• Why is it important to assign the correct codes to the diagnoses, services, and procedures that a patient has received?
• What are the repercussions of submitting incorrect coding and billing errors to the third party payers?

In at least 150 words
 

1. Propose what you believe are your greatest strengths in delivering  oral presentation.
2. Decide what will be your greatest challenges in delivering  oral presentation.
3. Analyze how you will leverage your strengths and address your challenges through your preparation.
4. Predict how preparing and delivering this speech will prepare you for your future career (medical billing and coding) and life experiences.

1)  

The final presentation topic I have chosen explores the integration of health information technology within the nurse-patient relationship and how this relationship improves quality of care at the bedside. My topic also explores how health information technology can be utilized to improve nursing clinical workflow efficiency and quality. Some conclusions I have drawn from the literature research are that utilizing technology at the point of care delivery has made a significant impact on positive patient outcomes. It is important to note that the proper utilization of this technology is paramount in safe patient outcomes and in aiding the bedside clinician to improve workflow efficiency, quality, and patient safety. I believe that this is a very relevant topic, especially as we may have all recently learned that a former nurse at Vanderbilt University Medical Center in Nashville, Tennessee was arrested and charged with reckless homicide for making a medication error that resulted in a patient’s death. A full review of the plight of this nurse, and the judgement made against her is beyond the scope of this post, but its relevance can be related to the information systems and technology at the point of care that were involved in this incident.

According to Darvish, Bahramnezhad, Keyhanian, and Navidhamidi (2014), in an ever-changing advancing healthcare system, technology plays a major role in education and nursing work. Because of the ever-increasing pace that technology develops, the literature notes the need for appropriate education technology programs. Darvish et al. (2014) notes that in order to integrate information technology to effect positive outcomes and improve quality, there needs to be educational arrangements made within an organization to create short term and long-term specialized courses to focus on target groups and their various levels of education. By focusing on these groups and identifying their needs regarding information technology education, the goal is to increase quality of care, safety, and ultimately improve clinical workflow efficiency.

In my current practice a well-designed electronic health record system (EHRS) has been implemented for years. The system we are using currently is EPIC. We currently have excellent workflow efficiency in our extremely busy practice setting. Medication administration safety is enhanced with an integrated scanning system. The only potential issue from my current practice that I can identify as problematic, is that in an extremely rushed preoperative or PACU environment it is very easy to override the scanning tool and administer a medication urgently at the clinician’s discretion. In a PACU during a post-surgical emergency this is essential but when a clinician is just rushed to keep up with the workflow, then this presents a concern.

References

Darvish, A., Barhamnezhad, F., Keyhanian, S., & Navidhamidi, M. (2014, June 24). The role of nursing informatics on promoting quality of healthcare and the need for appropriate education. Global Journal of Health Science, 6(6), 11-18. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4825491/

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2)  

Working on the final presentation has brought me to a few conclusions. First is that the nurse informaticists plays a key role in linking nursing and technology. This type of nurse takes their clinical knowledge and applies it to technology to improve patient outcomes. The nurse informaticists is crucial in being the change agent when it comes to introducing new technology or changes within technology at the bedside. Second conclusion is that using change theory is important for new technology to be accepted and successfully implemented into practice. The third conclusion is that technology is expanding at a rapid rate, the incorporation of electronic health records has made improvements in patient outcomes. The future of EHR applications have unlimited possibilities, however, ethical considerations need to be addressed. Just because technology can make improvements does not necessarily mean it should. And lastly, nurses at the bedside should be involved in the process of change. They are the stakeholders in change, the ones that experience the positives and negatives of incorporating changes into healthcare.

For the final presentation I am researching the interoperability of the EHR to improve triage accuracy. My focus is using EHR clinical systems such as clinical decision support systems to process data gathered during triage to support accurate triage acuity assignment. (Hebda, Hunter, Czar, 2019) Thus far in researching literature I have concluded that it is not just my experience in witnessing inaccurate triage assignments. Tam, Chung, and Lou (2018) research describes how worldwide there are problems in assigning accurate acuity levels despite the triage algorithm used. Experience and training are key factors in triage accuracy. Applying thinking algorithms could assist the triage nurse in making the important decision of how long a patient may safely wait to be seen in the emergency room. Monga (2017) discusses how incorporating “thinking” algorithms into EHRS can be done to guide practitioners in decision making. The question is should it be done? Ethical dilemmas arise, such as what if the algorithm applies the same biases as the nurse, or use of suggested acuity level is no longer a suggestion because the nurse becomes too dependent on the system. (Char, Shah, & Magnus, 2018) This application to the triage process would not create a change in nursing practice as it should be used as a support process and not a definitive decision process.

References

Char, D. S., Shah, N. H., & Magnus, D. (2018). Implementing machine learning in health care – Addressing ethical challenges. The New England Journal of Medicine, 378(11), 981–983. doi:10.1056/NEJMp1714229

Hebda, T., Hunter, K., & Czar, P. (2019). Handbook of Informatics for Nurses and Healthcare Professionals (6th ed.). New York, NY: Pearson.

Monga, K. (2017). Using machine learning to increase agility in HIM. Journal of AHIMA, 88(7), 30-32. Retrieved from https://search.proquest.com/docview/1912093679?accountid=34574

Tam, H. L., Chung, S. F., & Lou, C. K. (2018). A review of triage accuracy and future direction.BMC Emergency Medicine, 18(1), 58. doi:10.1186/s12873-018-0215-0

200 words for each response
 

Locate a news article or story related to a current event in healthcare policy. Some examples may be, but are not limited to healthcare reform, the Affordable Care Act, prescription drugs, healthcare costs, insurance coverage, healthcare fraud, transparency, or underinsured populations.

Provide a brief overview of the article, and include the URL link.

As a healthcare professional, has this raised any ethical questions or concerns for you?

How can a community health nurse (CHN) be involved as a change agent for related healthcare policies?