1. Go to at least two of the following insurance carrier websites that lay out their claim submission guidelines. Identify at least three differences between two of the insurance carrier’s policies. In a Word document, for each item you found, write one paragraph for each of the differences. Be sure to identify the carriers. Save the Word document as “SubmissionDifferences”.

• BCBS-IL Claim Submission Home Page (Links to an external site.)Links to an external site.
• Anthem Claims Submission Guidelines (Links to an external site.)Links to an external site.
• Cigna Claim Submission Guidelines (Links to an external site.)Links to an external site.

1. Research an insurance company website, such as Aetna, BCBS, or Cigna. Find a page where it provides instructions for submitting a claim. In a Word document, describe the process in terms a non-billing professional might understand, especially special cases or exceptions. Save the document as “ClaimProcess”  

 

  

American writer Nikki Giovanni once said: “Mistakes are a fact of life. It is the response to the error that counts” (Goodreads, 2012). Whenever you make an error when writing a prescription, you must consider the ethical and legal implications of your error—no matter how seemingly insignificant it might be. You may fear the possible consequences and feel pressured not to disclose the error. Regardless, you need to consider the potential implications of non-disclosure. How you respond to the prescription error will affect you, the patient, and the health care facility where you practice. In this Assignment, you examine ethical and legal implications of disclosure and nondisclosure of personal error.

Consider the following scenario:

· You are working as an advanced practice nurse at a community health clinic. You make an error when prescribing a drug to a patient. You do not think the patient would know that you made the error, and it certainly was not intentional.

To prepare:

· Consider the ethical implications of disclosure and nondisclosure.

· Research federal and state laws for advanced practice nurses. Reflect on the legal implications of disclosure and nondisclosure for you and the health clinic.

· Consider what you would do as the advanced practice nurse in this scenario including whether or not you would disclose your error.

· Review the Institute for Safe Medication Practices website in the Learning Resources. Consider the process of writing prescriptions. Think about strategies to avoid medication errors.

Write a 2- to 3- page paper that addresses the following:

· Explain the ethical and legal implications of disclosure and nondisclosure. Be sure to reference laws specific to your state.

· Describe what you would do as the advanced practice nurse in this scenario including whether or not you would disclose your error. Provide your rationale.

· Explain the process of writing prescriptions including strategies to minimize medication errors.

– This work should have Introduction and conclusion

– This work should have at 4 to 6 current references 

– Use at least 3 references from class Learning Resources

The following Resources are not acceptable:

1. Wikipedia

2. Cdc.gov- nonhealthcare professionals section

3. Webmd.com

4. Mayoclinic.com

Required Readings

**Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.

• Chapter 1, “Issues for the           Practitioner in Drug Therapy” (pp. 3–14)
            This chapter introduces issues relating to      drug therapy such as adverse      drug events and      medication adherence. It also explores drug safety, the           practitioner’s role and responsibilities in      prescribing, and prescription      writing.
• Chapter 59, “The Economics           of Pharmacotherapeutics” (pp. 1009-1018)
            This chapter analyzes the costs of drug      therapy to health care systems and      society      and explores practice guideline compliance and current issues in           medical care.
• Chapter 60, “Integrative      Approaches to      Pharmacotherapy—A Look at      Complex Cases” (pp. 1021-1036)
            This chapter examines issues in individual      patient cases. It explores      concepts relating      to evaluation, drug selection, patient education, and           alternative treatment options.

**Crigger, N., & Holcomb, L. (2008). Improving nurse practitioner practice through rational prescribing. The Journal for Nurse Practitioners, 4(2), 120–125.

Note: Retrieved from the Walden Library databases.

This article explores issues relating to prescription drugs, specifically the frequency in which drugs are prescribed to patients. It also examines factors to consider before beginning drug therapy plans with patients.

**Philipsen, N. C., & Soeken, D. (2011). Preparing to blow the whistle: A survival guide for nurses. The Journal for Nurse Practitioners, 7(9), 740–746.

Note: Retrieved from the Walden Library databases.

This article examines issues that nurses encounter when reporting errors in medical settings. It also outlines the role of ethics and the responsibility of nurses to notify all individuals who are impacted by a medical error.

**American Nurses Association. (2001). Code of ethics for nurses with interpretive statements. Nursing World. Retrieved from http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics-For-Nurses.html

This article outlines ethical standards in the nursing profession and identifies nine provisions of care that must be adhered to by all nurses.

**Anderson, P., & Townsend, T. (2010). Medication errors: Don’t let them happen to you. American Nurse Today, 5(3), 23–28. Retrieved from https://americannursetoday.com/medication-errors-dont-let-them-happen-to-you/

This article examines factors that lead to medication errors as well as consequences of these errors on patients and nurses. It also recommends methods for avoiding and eliminating medication errors.

**Drug Enforcement Administration. (n.d.). Mid-level practitioners authorization by state. Retrieved from August 23, 2012, http://www.deadiversion.usdoj.gov/drugreg/practioners/index.html

This website outlines the schedules for controlled substances, including prescriptive authority for each schedule.

**Drugs.com. (2012). Retrieved from http://www.drugs.com/

This website presents a comprehensive review of prescription and over-the-counter drugs including information on common uses and potential side effects. It also provides updates relating to new drugs on the market, support from health professionals, and a drug-drug interactions checker.

**Institute for Safe Medication Practices. (2012). ISMP’s list of error-prone abbreviations, symbols, and dose designations. Retrieved from http://www.ismp.org/Tools/errorproneabbreviations.pdf

This website provides a list of prescription writing abbreviations that might lead to misinterpretation, as well as suggestions for preventing resulting errors.

**Byrne, W. (2011). U.S. nurse practitioner prescribing law: A state-by-state summary. Medscape Nurses. Retrieved from http://www.medscape.com/viewarticle/440315

**Drug Enforcement Administration. (n.d.). Code of federal regulations. Retrieved August 23, 2012, from http://www.deadiversion.usdoj.gov/21cfr/cfr/1300/1300_01.htm

Chapter 3 Application Exercise 1

• Visit the DME coding system (DMECS) website at https://www.dmepdac.com/dmecs/ (Links to an external site.)Links to an external site. 
• Review the DMECS guide
• Explain the purpose of the DMECS, its uses, and users 
  • Include the results of searching on replacement socket and HCPCS code L8000

Chapter 4 Application Exercise 1

• Access the NDC-HCPCS crosswalk 
  • Locate the HCPCS code J2997
  • Identify the NDC codes for J2997
• Find the NDC Label for Cathflo activase. Search the Internet for the official site for this drug. Locate the billing FAQs
• Answer the following questions 
  • Is the configuration of the NDC codes HIPAA compliant? Why or why not?
  • How can the same HCPCS code have different NDC codes?
  • What NDC code is provided in the FAQs? 

Assignment Guidelines

• You have the choice to write a two-page paper double spaced or create a multimedia presentation to respond to the exercises
• Clearly label your response to each exercise in your submission

 

• Describe the PMHNP practice environment for Texas, highlighting restrictions or limitations for practice.
• Compare the PMHNP practice environment in Texas with a neighboring state or a state in which you would like to practice.
• Describe a professional and/or clinical practice issue a new PMHNP will need to consider and address with the certification, licensure, credentialing, or relocation process.
• Develop a checklist for passing the national certification exam, including a detailed timeline that includes academic preparation (study plan), registration, financial preparation, etc.

  

As a nurse, you serve an important role in identifying strategies to effectively manage health care resources and in leading health care quality improvement. You must be able to decide what leadership style or strategy to apply in a given situation to achieve an effective resolution of the issue. Read the following two scenarios and select one to focus on in this Discussion. Consider the leadership style or strategy that might be most effective in the scenario you selected.

Scenario 1

You work in a for-profit nursing home, with about 100 beds, on a 20-bed unit that is largely patients with Alzheimer’s disease. Your patient mix is predominantly Medicare and Medicaid patients. Your nursing home is part of a larger system that includes a major medical center, as well as VNA, outpatient dialysis, and a fully integrated network. Your nurse manager is getting feedback from the hospital that your nursing home is sending too many patients to the ED who really don’t need to go. How would you go about figuring out what could be done at the nursing home to prevent avoidable ED visits?

Scenario 2

You’ve been associated with an outpatient cardiology clinic that is part of a large academic medical center. Your patients are mostly charity care and managed Medicaid. Most have a prescription plan, but none have a “family doctor” and use the clinic (and the ED) regularly. Most are unfamiliar with their medications and do not have the resources for care coordination in their family/social network. About 25 CHF patients have been “lovingly,” but inappropriately, called “frequent fliers” because of their inability to manage their own care, their frequent visits to the ED, and their “one night stays” paid at the observation rate. As a staff nurse in this clinic, describe the strategies you could devise for you and your fellow staff nurses targeting these 25 patients. Find at least one article from the professional literature to corroborate your recommendations.

By Day 3

Select one of the scenarios, and post the following:

Describe the most appropriate leadership style and/or strategy to apply in the scenario you chose in order to implement the recommendations successfully. Justify your selection.

Support your response with references from the professional nursing literature. Your posts need to be written at the capstone level (see checklist)

Notes Initial Post: This should be a 3-paragraph (at least 350 words) response. Be sure to use evidence from the readings and include in-text citations. 

  

The final step is to develop the plan discussing the steps clearly and succinctly. The plan must be evidence based .

By Day 4

Post an explanation of how you could apply key interventions supported by the scholarly research evidence to potentially help resolve the issue in measurable ways. Continue to collaborate with the selected individuals in your practice environment as needed in the development of the Practice Experience Project, and share this information with your group.