APRN Legal Case Study

Medical biller is a position that will require you to take in medical claims and code them and bill out medical claims to insurance companies, Medicare and Medicaid on a daily basis. You will have to reconcile Explanation of Benefits (EOB) weekly. Verify if insurance companies require that patients get PA for certain procedure and products. Five requirements for Medical Biller position 1. How to bill claims 2.

The state of North Carolina has several mental health agencies that target the specific needs of youth and adults within the community. Each agency must oblige by the North Carolina Division of Health Service Regulations of Mental Health Licensure and Certification Section ( DHSR) as an operating facility. By Law, mental health agencies must be equipped with licensed professionals that are able to conduct assessments and create service plans for their clients. To obtain this license a counselor must obtain a counseling degree from an accredited University and take the state board counseling test to receive their License Professional Counselor Associate (LPCA). This is the current status that Mrs. Stroman holds with the state of North Carolina.

Each state has its own eligibility program while determining the type, amount, duration, and scope of services provided. States also provide their own sets for rate of payments with administering its own Medicaid program. The services provided is based differently depending on the state considering they have free control over the plans provided; although there are mandatory federal regulations that states are required to meet to receive federal funding such as inpatient and outpatient hospital, prenatal care, vaccines for children, physician, nursing facility services for those aged twenty one or older, family planning services and supplies, rural health clinic, home healthcare for those eligible for skilled-nursing, laboratory and x-ray, pediatric and family nurse practitioner, nurse-midwife, federally qualified health-center and ambulatory services, and early and periodic screening, diagnostic, and treatment services for children under twenty-one. There are other optional Medicaid programs, thirty four that are approved in which states are able to provide and still receive funding such as diagnostic and clinic services, intermediate care facilities for mentally retarded, prescribed drugs and prosthetic devices, optometrist services and eyeglasses, nursing facility services for children under the age of twenty one, transportation services, rehabilitation and physical therapy, and home and community based care to certain persons with chronic impairments (Crosta). The eligibility guidelines must be provided by states considering the programs are geared towards those with low incomes but those persons have to meet other requirements based on age, pregnancy and disability status, and other assets along with their citizenship.

Paying for assisted living is different than paying for a nursing home. For assisted living, individuals may use their secretive money foundations to pay for the housing and facilities provided in assistant living accommodations. Varying on homes, trusts can array from one thousand to numerous thousand dollars each month. Long-term care insurance is also a form of pay for assisted living. As a regulation, most extensive term care insurance procedures have an aided living assistance, either straightforwardly or within a home health care expense.

Any specialty, in addition to the domain of activity, must have a core of principles and rules needed to delineate and to distinguish themselves from other specialties. GM principles are derived from concrete problems that must be solved: the need for accessibility of patients to healthcare, the prolonged evolution of some diseases that implies the continuity of care, the impossibility of "fragmentation" of the body,

There are 3 variables they talkabout case-mix which is the residents characteristics, facility characteristics which issize, pay, cost, location, and certification status, and market characteristics which isMedicaid policies. I think that staffing measures definitely has a good association withquality care of residents in a nursing home. If a patient has little time with professional Studies Show Association between Staffing and Quality of Care 3nursing staff they won’t receive the amount of attention they deserve and therefore notreceive quality care. I think a big point in this article is the amount of time spent with patients and theamount of staff you have on hand at a facility. These points are so important because ifyou don’t have enough staff and a lot of patients you may want to help all of them andgive them quality care

Hospital compare helps citizens find information for hospitals all over the country. This information helps the patients and their families make the best choice for their monetary restrictions and their health choices. This helps them find out whether the quality of care is adequate for their needs between many hospitals in the patient's home area. Hospital compare helps the patient by making the decision process easier, and making hospitals improve their health care quality. Patients can find a variety of information about the hospitals quality; including general ratings of the hospital, general information, payment and value of care, timely and effective care, and much more information on this website.

The statutory law arises from the Congress and the state legislatures (Masters, 2015). Examples of these laws include the Nurse Practice Acts. State Boards are responsible for establishing regulatory law when they enact rules and regulations. A good example is that of reporting of incompetent nurses and those exhibiting unethical behavior. Courts are also legislators of the rules which govern the conduct of the nurses.

Each of the selected health facilities represented different levels of healthcare service delivery within the hierarchy of healthcare provision in Kenya. Thus the Jaramogi Teaching and Referral Hospital (JOOTRH), Kisumu County Hospital (KCH) and St. Monica’s Hospital (faith-based, private health facility. The total sample for the quantitative component of the study consisted of 72 maternal care nurses, thus nurses working in the maternity ward (antenatal, labour and post-natal wards) and MCH clinics (antenatal and post-natal clinics). These were enrolled, registered, baccalaureate and postgraduate nurses employed at the facilities by the time of the research.

During this phase the case managers are reaching out to the patients and their support system to see how things are going. Lastly is the evaluating phase, which is determining the results of achieving the case management plan of care and their effect on the patient’s condition. This phase basically focuses on different types of outcomes of care like, financial, clinical, physical functioning, and more. Depending on the depth of the phase, stratifying risk may also be part of the process. In some settings like, health insurance and chronic

Shi and Singh (2015) states that the MedPac was established by the Balanced Budget Act of 1977 as an independent federal agency to advise the US congress on different issues that affect the Medicare program. MedPac regulations consist of analyzing payments to private health care providers that participates in Medicare, access to care, and quality of care (p. 214). Article written by Jill Wechsler (20090 states that MedPac concluded that Medicare payment system should reward value instead of volume to help encourage coordination of care with the different providers as well as constrain cost growth. They proposed alternatives that could help improve physician’s practices by support for graduate medical education, improve chronic care and

Another point of difference lies in the fact that the

The CM department can gather information of all processes concerning the treatment, nursing, and after-treatment of the patients to perform better services for patients (Wulff et al., 2008). Concerning the new strategy implemented by RWTH Hospital, the margin between estimated bed time and actual bed time has been

The 1990 NHS and Community Care Act came into force to make new policy and arrangement in healthcare services to establish National Health Service trust and for managing better processes of providing services. At the end of June 1990, the Bill introducing the National Health Service and Community Care Act 1990 received the Royal Ascent (Davies, 1991, p. 17). Introducing community care service to the people for ensuring the entitlement of health and social care provision. Especially considering care for vulnerable groups, making the right decision plays important role in this act. Affected by problems of ageing, mental illness, mental handicap or physical or sensory disability need to be able to live in their own homes, or in ‘home’ setting

Before working in the health care field, soon to be registered nurses have to follow procedures in order to achieve their current proposition. RNs are included as one of the certified occupations from predetermined standards, which is required by taking courses and final examinations. Students must graduate from an accredited program and obtaining an associate’s degree or bachelor’s degree in nursing. The nursing degree completion is subject to the will of determination in accomplishing the courses in two years to achieve an associate degree or four years for a bachelor’s degree. After graduating, candidates are advised to register for the computerized NCLEX-RN examination for a cost of $200.