Write a 650-1300 word response to the following questions: 

1. Explain multicultural communication and its origins.
2. Compare and contrast culture, ethnicity, and acculturation.
3. Explain how cultural and religious differences affect the health care professional and the issues that can arise in cross-cultural communications.
4. Discuss family culture and its effect on patient education.
5. List some approaches the health care professional can use to address religious and cultural diversity.
6. List the types of illiteracy.
7. Discuss illiteracy as a disability.
8. Give examples of some myths about illiteracy.
9. Explain how to assess literacy skills and evaluate written material for readability.
10. Identify ways a health care professional may establish effective communication.
11. Suggest ways the health care professional can help a patient remember instructions.

This assignment is to be submitted as a Microsoft Word document.

 Pamela Keeme 

Reimbursement Methodologies

1) Focus on Payment Methodologies and discuss the various payment systems. Demonstrate understanding of fee for service, cost based, and prospective payment systems. Just like coding systems are different, payment methodologies for inpatient hospital, outpatient hospital, and professional claims are also different. Many commercial payers follow the lead of Medicare once it has implemented a specific payment system(Aalseth, P. 2015). 

Fee For Service- This is the most traditional, simple payment system. For this payment system, a service is billed using a CPT or ICD procedure code. The payer has a fee schedule with a set reimbursement amount for each service it covers. The provider gets the fee schedule amount less any deductible or coinsurance owed by the patient. Most physician services are paid according to a fee schedule. Clinical laboratory services are paid based on a laboratory fee schedule, and ambulance services are paid on an ambulance fee schedule.

Cost Based or Reasonable Cost- Under this payment system, providers or facilities submit an annual cost report that details the expenses of running their businesses. There are extensive rules for completing this cost report. Examples are: data on bed utilization, salaries by cost center, expenses by cost center, indirect costs related to items such as medical education, cost-to-charge ratios, capital expenditures, and other items. In most cases the facility has been receiving periodic interim payments from the payer throughout the year, and the cost report is then used to “settle” or reconcile the costs to the payments already received. For Medicare, the cost reports are submitted to the Fiscal Intermediary (FI), which reviews and/or audits the cost report and then submits it to the CMS for reporting. PIP (periodic interim payments) are available to inpatient hospitals, skilled nursing facility services, hospice services, and critical access hospitals. These facilities are supposed to self-monitor their PIP payments to make sure they are not receiving overpayments or they can be penalized if overpayment exceeds 2% of the total in two consecutive fiscal reporting periods.

Prospective Payment System- In order to change hospital behavior to encourage more efficient management of medical care, Medicare introduced hospital inpatient prospective payment in 1983. Using a system that was developed in the 1970s by Yale University, reimbursement to hospitals was based on diagnosis-related groups (DRGs). Data already appearing on the claim form are used to assign each patient discharge into a DRG: Examples are Principal diagnosis, Complications and comorbidities (CCs), Surgical procedures, Age, Gender, and Discharge disposition (died, transferred, went home). Once a DRG has been assigned, the determination of the reimbursement amount can start. Each DRG has a relative weight assigned to it. Patients in a given DRG are assumed to have similar conditions, receive similar services, and use similar amounts of hospital resources. The prospective payment system is based on paying the average cost to treat patients in that DRG. The DRG weights are adjusted annually. The more complex the DRG, the higher the weight.

2) Explain medical necessity and how it impacts payment- To determine medical necessity, it involves comparing the procedure being billed to the diagnosis submitted. If you receive a denial notice from the payer that the procedure was “not medically necessary”, it means that your payer does not think the procedure or test was justified for the diagnosis given. Medicare carriers publish what are known as “Local Coverage Determinations” (LCDs) that contain lists of diagnosis codes that validate procedures. If your diagnosis is not on the list, your claim will be rejected. If the provider of the service knows in advance that a service is likely to be deemed not medically necessary, he or she can ask the patient to sign an Advance Beneficiary Notice (ABN) in which the patient acknowledges the possibility the claim will not be paid and agrees to be financially liable for the charge. 

3) What has been the effect of payment methods on coding? Medical billing procedures have been much more effective since the advent of the CPT medical coding system. Developed by the AMA, the CPT system was designed to help facilitate and standardize medical billing practices. The coding system consists of alpha-numerical codes which are designated to describe the various services and treatments a doctor or medical facility performs on their patients. These codes are entered into a database system which is used for billing insurance companies, Medicare and Medicaid. Through the use of this billing system, medical professionals are better able to keep track of their financial records and receipt of their medical payments(findacode.com). 

Aalseth, P. (2015). Medical Coding. What It Is and How It Works. Second Edition. Burlington, MA. Jones & Bartlett Learning

https://www.findacode.com/articles/the-impact-of-coding-system-on-medical-billing

Post 2

 Richard Matos Week 4 – Payment MethodologiesCOLLAPSE

Fee for service is a method in which doctors and providers receive payment for services provided and the most traditional payment mechanism.  Services are billed using a CPT or ICD code, The provider gets the fee schedule amount less any deductible or coinsurance owed by the patient. Laboratory and ambulance services are paid on a laboratory and ambulance fee schedule. (Aalseth P.T., 2015).

Under Reasonable Cost or Cost Based providers and facilities present a detail report of the expenses of running their hospitals or clinics.  The reports include bed utilization data, salaries, expenses by cost center, medical education, cost to charge ratio, capital expenses, and other items. (Aalseth P.T, 2015). 

In order to control the cost of Medicare, Medicaid, and other insurance programs, Medicare introduced Hospital inpatient prospective system in 1983.  Reimbursement will be based on Diagnosis-Related Group (DRG’S).  Data already appearing on the claim form are used to assign each patient discharge into a DRG; Principal diagnosis, Complication, and comorbidities, surgical procedures, age, gender, and discharge disposition.  Once a DRG has been assigned, the determination of the reimbursement amount can start. (Aaselth P.T., 2015).

Medical necessity involves comparing the procedure billed to the diagnosis submitted. Local  Coverage Determinations are a list of diagnosis codes that validates procedures such as X-rays, EKG’s and others. If the procedure billed was not on the list the claim will be rejected.  

Since the implementation of DRG’s coding made a difference in reimbursement.  Coders were elevated out of the dark and into the financial limelight. Medical records departments were turned into health information management departments.  The potential dollars to be made was an incentive to coders to use the right codes. (Aaselth P.T., 2015) 

Reference

Aalseth, P.T. (2015). Medical Coding, what is it and how it works, (2nd ed.) Sudbury, MA: Jones & Bartlett Learning

Write a fully developed and detailed APA essay addressing each of the following points/questions. There is no required word count; be sure to completely answer all the questions for each question in detail. Separate each section in your paper with a clear heading that allows your professor to know which bullet you are addressing in that section of your paper. Sources are not required; however, if sources are used make sure to cite using the APA writing style for the essay and complete a reference page. The cover page is required. Review the rubric criteria for this assignment.

Utilize the databases identified in the text to locate an Evidence-Based Practice Guideline, related to your topic identified in Module 1. Perform a rapid critical appraisal of the Evidence-Based Guideline by answering the following questions in APA format. All questions should be answered in detail and explanations offered according to guideline content when applicable.

• Who were the guideline developers?
• Were the developers of the guideline representative of key stakeholders in this specialty (inter-disciplinary)?
• Who funded the guideline development?  
• Were any of the guideline developers funded researchers of the reviewed studies?
• Did the team have a valid development strategy?
• Was an explicit (how decisions were made), sensible, and impartial process used to identify, select, and combine evidence?
• Did its developers carry out comprehensive, reproducible literature review within the past 12 months of its publication/revision?
• Were all important options and outcomes considered?
• Is each recommendation in the guideline tagged by the level/strength of evidence upon which it is based and linked to the scientific evidence?
• Do the guidelines make explicit recommendations (reflecting value judgments about the outcomes)?
• Has the guideline been subjected to peer review and testing?
• Is the intent of use provided (i.e. national, regional, local)?
• Are the recommendations clinically relevant?
• Will the recommendations help me in caring for my patients?
• Are the recommendations practical/feasible? Are resources (people and equipment) available?
• Are the recommendations a major variation from current practice? Can the outcomes be measured through standard care?

The growth, development, and learned behaviors that occur during the first year of infancy have a direct effect on the individual throughout a lifetime. For this assignment, research an environmental factor that poses a threat to the health or safety of infants and develop a health promotion that can be presented to caregivers.    

Create a 10-12 slide PowerPoint health promotion, with speaker notes, that outlines a teaching plan. For the presentation of your PowerPoint, use Loom to create a voice over or a video. Include an additional slide for the Loom link at the beginning, and an additional slide for references at the end.

Include the following in your presentation:

1. Describe the      selected environmental factor. Explain how the environmental factor you      selected can potentially affect the health or safety of infants.
2. Create a health      promotion plan that can be presented to caregivers to address the      environmental factor and improve the overall health and well-being of      infants.
3. Offer      recommendations on accident prevention and safety promotion as they relate      to the selected environmental factor and the health or safety of infants.
4. Offer examples,      interventions, and suggestions from evidence-based research. At least      three scholarly resources are required. Two of the three resources must be      peer-reviewed and no more than 6 years old.
5. Provide readers      with two community resources, a national resource, and a Web-based      resource. Include a brief description and contact information for each      resource.
6. In developing      your PowerPoint, take into consideration the health care literacy level of      your target audience, as well as the demographic of the caregiver/patient      (socioeconomic level, language, culture, and any other relevant      characteristic of the caregiver) for which the presentation is tailored

Respond to this post with a positive response :

Ask a probing question, substantiated with additional background information, evidence or research.

Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.

Offer and support an alternative perspective using readings from the classroom or from your own research in the Walden Library.

Validate an idea with your own experience and additional research.

Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.

Expand on your colleagues’ postings by providing additional insights or contrasting perspectives based on readings and evidence.

Use  references

EXAMPLE OF A REFERENCE:

If you cannot locate a doi number, this is how the reference should look: 

Quelly, S. B. (2017). Characteristics Associated with School Nurse Childhood Obesity Prevention Practices. Pediatric Nursing, 43(4). Retrieved from https://www.pediatricnursing.net/issues/17julaug/abstr5.html

                                             MAIN POST

Scholarly Writing and Plagiarism

                Learning is a journey and not a destination. A part of this journey was to use Grammarly and SafeAssign. I will discuss my experience with those two platforms as well as my perception of paraphrasing and plagiarism. The internet is full of resources, so I will be sharing an online resource that supports scholarly writing. Finally, I will share two American Psychological Association (APA) formatting rules that I believe are useful for academic writers.

                I have never used Grammarly before, but I like that I can check grammar in real time. I did not know such a tool was in existence and I will be using Grammarly for all my assignments going forward before sending. However, SafeAssign is not a new tool for me. When I went to Western Governors University, I used TurnItIn, which is similar to SafeAssign. It checks how much of your paper matches other known scholarly works. I wrote a sample paragraph with SafeAssign, and it was a 0% match. I like to see my works matching at 5% or less as a matter of philosophy. It is easy to avoid plagiarism if two things are remembered. Use thoughts that originate from your cranium and cite works according to APA rules and Walden University requirements. During this process, my insight was learning how to paraphrase better. Walden University (2012) states that paraphrasing is beyond simply rearranging a sentence and choosing synonyms. I realized paraphrasing is about turning the whole idea into your own words and then citing the author.

                Scholarly writing is a term that can be confusing for many students. I had no idea what it meant until I researched the topic. According to Jackson State University (2015), scholarly writing is structured and seeks feedback from the audience. It would seem that this is the purpose of using discussion boards in an online learning environment. I believe that this online resource is useful, and I plan on adding it as a bookmark as a reminder of the essentials of scholarly writing.

                As previously mentioned, proper APA style and formatting is essential in scholarly writing. A rule that I was not versed in was related to in-text citations with more than five authors. The APA Manual states, “when a work has six or more authors, cite only the surname of the first author followed by et al” (American Psychological Association, 2010, p. 175). Also, I did not know that the following rule existed. According to the American Psychological Association (2010, p. 170), presenting your existing work as new when it is not is the definition of self-plagiarism. I found this to be an interesting rule that I had not considered before and will make sure I never do.

References

American Psychological Association. (2010). Publication Manual of the American Psychological Association (6th ed.). Washington, DC: American Psychological Association.

Jackson State University. (2015). What Is “Scholarly Writing”? Retrieved from http://www.jsums.edu/wrightcenter/2015/04/29/what-is-scholarly-writing/

Walden University. (2012). Walden University: Proofreading and revising. Retrieved from http://writingcenter.waldenu.edu/872.htm