Inaccurate Reimbursement Analysis

They should be hold accountable for any breach in protocols. • Present format for electronic documentation does not allow for comprehensive clinical documentation during follow-up visit. Efforts should be made to upgrade the electronic medical record system to the standard of that expected for a medical center and research institute. This is to allow for proper documentation according to the industrial standard, and easy retrieval of patient’s information for clinical research. There is a need to employ a clinical documentation improvement specialist (CDIS) in this

A patient is admitted to Nightingale Community Hospital to the surgical unit following an infection to a post-op wound. There were several deficiencies found on the patient’s tracer audit once the patient was admitted to the hospital. One deficiency that was found was that the patient was given medication related to pain and the patient was not reassessed properly per Joint Commission Standards (JC). The deficiency found is within the pain assessment policy of the hospital.

The National Practitioner Data Bank (NPDB) is an electronic information clearinghouse used by health care professionals and authorized organizations where data is collected and managed It contains data on medical malpractice payments and certain adverse actions related to health care practitioners created by congress in order to improve health care quality by preventing fraud and abuse and encouraging patient safety. The website offers a place where authorized users such as health care professionals and organizations are able to submit negative reports confidential that include medical malpractice, Negative actions or findings by a peer review organization, Negative actions or findings by a private accreditation organization, Health care-related

The Joint Commission’s tracer methodology is used to ensure compliance standards are met, as well as to “trace” and document the level of care provided to patients in order to make improvements to the facility’s health care delivery system. Patients requiring services that utilize the entire continuum of care spectrum are selected in an effort to gather sufficient information needed to identify areas with potential risks and safety concerns. As the patients’ course of care progresses across the system, Joint Commission surveyors evaluate each department 's policy and procedure on data management, infection control and medication management process. Health information management is impacted by the “tracer methodology” because HIM must ensure

Also, all the information on the document must be explained at the patient’s discretion. If the patient does not fully understand the information provided with the risks and benefits they will not receive proper treatment and health

Bedside reporting has been shown to improve communication and quality of handoff between nurses. It is also credited to promote patient safety and improve patient satisfaction. Patient satisfaction, patient safety and nursing communication and quality of report from a 32 bed surgical hospital in Dallas, Texas is to be evaluated using various surveys, HCAHPS scores, incident reports, and call light logs. Data will be collected 2 months prior and 6 months following the implementation of bedside report. Scores and communication survey results will be reviewed in this time period to determine increases or decreases from pre-implementation results using traditional nurse-to-nurse report..

Direct and limited reimbursement plans are different. Direct expense reimbursement plans designate reimbursement of all expenses that are reasonable within the sales effort of salespeople (Johnston & Marshall, 2009). Limited expense reimbursement plans allow for a pre-set limit of expenses (Johnston & Marshall, 2009). The pre-set limit of expenses can be reimbursed for specific expense occasions or provided as a one time expense budget payment. The type of reimbursement plan that would work best for the MedTech Pharmaceuticals company would depend upon the goals of the company.

Once, receipt of the Notice Act has been provided to the patient, and the patient signs or refuses to sign, a copy is made for the patient and a copy is scanned into the Electronic Medical Record (EMR). A Utilization Review note is documented in the EMR. After this process is completed, there is continued collaboration with the physicians, care coordinators and discharge facilitators to ensure patients receive quality efficient care as they transition through the continuum of care whether that is being discharged home or admitted as inpatient. As a member of the Health Care Management Team and UM, RN I can help improve the organization’s position by working with the physicians and helping them by providing education and real-time assistance in determining the correct status of the

Reimbursement Methods What are the definitions of and the similarities and differences of the following reimbursement methods; capitation, discount, per diem, case rate, DRG’s/MS-DRG’s? Starting with capitation. Capitation is prepayment for services, per member per month. A physician or facility is paid the same amount of money every month for each member or patient regardless if that patient is actually seen or receives services and regardless of how extensive of services that member/patient have received. The capitation amount is calculated and set at the fixed amount usually for one year.

Medicare reimbursement services are an essential aspect of healthcare in the United States. Medicare is a government-funded program that provides health insurance to people over 65, those with certain disabilities, and those with end-stage renal disease. Medicare reimbursement services refer to the process of healthcare providers receiving payment for their services from the Medicare program. In this blog post, we will discuss how healthcare providers can take advantage of Medicare reimbursement services to improve their revenue and patient care.

Healthcare Reimbursement Healthcare is made up of many factors. Among those factors are provider reimbursement and the different types of financial methods used by the patients to acquire healthcare services. Provider reimbursement is important and necessary in order to maintain the continuation of healthcare. Like every organization, including non-profit organizations, require revenue in order to pay their healthcare providers, expenses accrued, and to obtain the supplies needed to aid in rendering services. With that said, this is why there are many financial methods such as third-party payers, government agencies, private health insurance, and patient payments.

When the Hospital Standardization Program established their initial set of minimum standards, one of the prescriptive measures required healthcare organizations to maintain medical records for patient treatment. The necessity of creating, and preserving a detailed account of a patient’s history, laboratory results, and treatment seems rudimentary today. The Hospital Standardization Program made significant advances in enforcing proper documentation. Building on that legacy, TJC strengthened standards involving appropriate medical documentation by including strict timelines for completion. For example, TJC mandates a patient’s History and Physical (H&P) report be completed within 24 hours of admission.

Reimbursement Reimbursement for services may differ for NPs depending on the restriction of services they can provide as outlined by their state’s practice laws (Kaiser Family Foundation, 2011). Credentialing and payment that is managed by many health plans provide payment according to the services that an NP can provide in each state, or from a federal perspective, Medicare will only pay 85% of the full physician rate to a billing NP or Physicians’ Assistant (PA). This is because the laws are not unified throughout all 50 states (Cassidy, 2012). Many NPs do not feel that this payment model it fair for several reasons (S. S. Gordner, personal communication, July 13, 2016).

If a doctor changes a record, it will be inconsistent with record written by other doctors and nurses in the hospital (John). Especially when there are numerous versions of the same record, any change made in the record is easily identifiable. Furthermore, falsification of records results in unchronological timeline of care, which forensic experts can be consulted to find the discrepancy in aspects of the chart (John). On top of that, according to John J. Ratkowitz, a medical lawyer, “if a doctor falsifies a medical record and you can prove this, you have the best proof possible on that issue available, since they would not bother changing a record to hide or add a fact if it was not important to a patient's care and a potential litigation” (John). As mentioned, most doctors aren’t able to falsify medical records as the patient would have an upper hand in court case, and the changes they make are easily detectable.

The negligence demonstrated in withholding treatment shows that the hospital staff’s inaction is below the expected standard. It may also cause the patient’s condition deteriorate (Hope, Savulescu, & Hendrick,