How Is ‘Underuse’ ‘Overuse’ And Medically Necessary Defined?

Providers and payers use UM to eliminate underuse and overuse of medically necessary healthcare services. The purpose of UM is to ensure that patients receive only medically necessary services at the least possible cost. Clinical practice guidelines, research evidence, and professional consensus are considered when identifying overuse and underuse of healthcare services. According to your readings how is ‘underuse’ ‘overuse’ and medically necessary defined? Why is this important to know?

 

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Define The Terms Written In In Bold For Us. How Do You Use These Trends In Your Organization?

Utilization trends can be reviewed before a patient receives services through prospective review, during the delivery of services through concurrent review, or after the patient receives services through retrospective review

Define the terms written in in bold for us. How do you use these trends in your organization? 150 words or more

 

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Unit III Essay Data Entry At The Point Of Care And Unit IV Essay Understanding Electronic Orders

Data Entry at the Point of Care

After reading the required chapters on Increased Familiarity with the Software and Data Entry at the Point of Care, complete and submit the following in an APA formatted scholarly essay:

· Begin your essay with an introduction explaining the purpose of the essay.

· In no more than one paragraph, describe the functions of the ROS button located on the Toolbar.

· In no more than one paragraph, describe the functions of the Export PDF button.

· In no more than two paragraphs discuss the components of SOAP charting

for the following scenario (include the list and forms that may be used):

A 21 – year-old female has come to the physician complaining of chest pain with shortness of breath. She says she has been wheezing and coughing for one week. Her vital signs are P-150, B/P–150/100, R–60,T- 99.6. Following physical examination, the physician decides she has been experiencing tachycardia and has seasonal asthma.The physician gives the Medical Assistant an order to administer a breathing treatment using the nebulizer and 2.0mg of albuterol sulfate. Then the Medical Assistant is to take the female’s vital signs again.

· Important reminder – do not forget to include a reference page, including all sources cited in your essay. The essay requires a minimum 500 word response.

·Submit before the assignment deadline.

Format your Research Paper using APA style. Use your own words, and include citations and references as needed to

avoid plagiarism.

Reference: Gartee, R. (2011). Electronic health records: Understanding and using computerized medical records (2nd ed.). Upper Saddle River, NJ: Pearson Education.

Chapter : 4 & 5

Unit IV Essay

Understanding Electronic Orders

After reading the required chapters on Understanding Electronic Orders and Problem Lists, Results Management, and Trending, complete and submit the following in an APA formatted scholarly essay:

· Begin your essay with an introduction explaining the purpose of the essay.

· In no more than three paragraphs, describe the five basic rights of drug ad ministration that must be followed to ensure that the physician administers the drug correctly.

· In no more than two paragraphs, describe the legal and ethical issues surround handling medication errors.

· In no more than one paragraph discuss the components of

SOAP charting for the following scenario (include the list and forms that may be used):

A 35 year old female in her second trimester of pregnancy calls the

OBGYN office stating she has acid reflux. She states prior to pregnancy, she used

To take Tagamet and wants to ensure that it is still ok to take being pregnant. How

Can you find this information and what should you do once you locate it?

· Important reminder, do not forget to include a reference page, including all sources cited in your essay. The essay requires a minimum 500 word Response.

· Submit before the assignment deadline.

Be sure to support your work with specific citations from this week’s required reading and any additional resources. Format your Research Paper using APA style. Use your own words, and include citations and references as needed to

avoid plagiarism.

Reference: Gartee, R. (2011). Electronic health records: Understanding and using computerized medical records (2nd ed.). Upper Saddle River, NJ: Pearson Education.

Chapter 6 &7

 

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Managed Care Issues

The “Maine” Issues in Managed Care

Election time is coming up again in Maine, and gubernatorial challengers have started raising concerns about the steady rise of taxes in the state. The media focus is becoming more intense, and the present governor, George Mayes, is looking for ways to save money – and his job. After the last election, he cut funding to education and raised the state tax on gasoline, and the outcry from the teachers unions and motorists throughout the state nearly got him recalled. He now realizes that he needs to find a way to cut the budget that will make him look like a hero. He chooses health care reform as the battleground for re-election.

You are the health care advisor to Governor Mayes. The Governor calls you in for a meeting and notes that the costs of the state’s Medicaid program continue to spiral upward and that something needs to be done about it. When you agree that costs need to be contained, the governor says that he is considering whether to engage a company to investigate the implementation of a managed care operation such as Medicaid. He asks you for some advice on how managed care could address the unique economics of the health care field.

Discuss four (4) specific shortcomings that exist in health care economics and six (6) economic consequences of these shortcomings. In addition, discuss four (4) ways that managed care organizations (MCOs) can impact these economic concerns or issues.

 

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Question Help Set 1 & 2

Question set 1

1. Who can sign a medical release form (authorization) to obtain PHI?

Your response should be at least 75 words in length.

2. What are the civil and criminal penalties for misappropriation of personal health information (PHI)?

Your response should be at least 75 words in length.

3. Which EHR signatures are not considered to be valid electronic signatures and why? In addition, what are the three components of a valid electronic signature? Be sure to include a brief summation of each.

Your response should be at least 200 words in length.

4. Outline eight Electronic Data Interchange (EDI) HIPAA transactions. In addition, describe the insurance verification (claims, payments, and eligibility) procedure prior to EDI HIPAA transactions. Was the procedure efficient? Why or why not?

Your response should be at least 200 words in length.

Gartee, R. (2011). Electronic health records: Understanding and using computerized medical records (2nd ed.). Upper Saddle River, NJ: Pearson Education.

include citations and references as needed to avoid plagiarism.

Question set 2

1.What are the HIPAA guidelines for provider-to patient email communication?

Your response should be at least 75 words in length.

2. Would you compare the way the Internet operates to the telephone or post office? Justify your response.

Your response should be at least 75 words in length.

3. Merita Roberts, is a 59 year-old who arrives for her routine follow-up visit for her known diagnosis of Diabetes Type II. She mentions today that she has had occasional cramps and weakness on the left side of her body. While the nurse is checking her, she notices her looking at the computer monitor. The monitor is displaying the screen saver for the new E-Visit program. She ask “What is E-Visit?”

(a) How will you explain the advantages and disadvantages of the Internet (E-Visit) on healthcare?

(b) What precaution should be taken to ensure patients do not see another patient’s PHI on the computer monitor?

Your response should be at least 200 words in length.

4. Discuss the benchmarks for Patient-Centered Medical Home. Be sure to include the nine PCMH standards.

Your response should be at least 200 words in length.

Gartee, R. (2011). Electronic health records: Understanding and using computerized medical records (2nd ed.). Upper Saddle River, NJ: Pearson Education.

include citations and references as needed to avoid plagiarism

 

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Discussion – Patient Compliance

Module 11 Discussion – Patient Compliance 1 full page. No need for APA formatting. thanks . Just read the sentences and answer the questions. Edith Dawson came to Rasmussen Clinic because she was experiencing sight disturbances, constant thirst, and fainting spells. After examining Edith, Dr. Sobiech ordered a glucose tolerance test. Certified Medical Assistant Wanda Lawry gave Edith a special diet that she was to follow for the 3 days preceding the test and instructions regarding fasting before the test. Edith has returned to the clinic to have test. “Did you follow the diet I have you Mrs. Dawson?” Wanda asks. “Yes I did.” “Did you have anything to eat this morning?” “No, but I did have a cup of coffee. I thought it would be all right because I drank it black. I can’t start the day without my coffee.” Should Wanda perform the test? Explain your answer. How can Wanda emphasize the importance of following the diet, fasting, and test instructions? What can Wanda do to try to ensure Edith’s cooperation?

 

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Putting a Band-Aid on Nebraska Medicaid

You are the assistant director for the Medicaid program in the state of Nebraska. The director has decided that it is time to review why the managed care and public policy objectives of implementing the program are not producing the results originally contemplated. Nebraska’s Medicaid staff is limited. Its administrative functions are generally dispersed across the state, rather than centralized. Its database related to care patterns is practically nonexistent. State law prohibits the program from extensive health care marketing. In order to simplify enrollment processes, Nebraska only considers one month’s income as a part of its eligibility process. In addition, Nebraska requires a $30 co-pay for all services from recipients who have income above the poverty guidelines. Nebraska has very few providers per capita.

The director asks you to draft a memo for discussion at the next Medicaid committee meeting that identifies seven (7) problem areas in the Nebraska Medicaid Managed Care Program and explains how each problem could arise. In addition, the Director would like you to write a brief conclusion to the memo explaining how the Program could improve.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.

Medicaid managed care: Lessons from five states Gold, Marsha;Sparer, Michael;Chu, Karyen Health Affairs; Fall 1996; 15, 3; ProQuest pg. 153

Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.

Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.

Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.

Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.

Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.

Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.

Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.

Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.

Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.

Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.

Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.

Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.

Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.

 

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Coaching and mentoring should be a core competency of nurses prepared at the graduate level.

Answer the following:

Coaching and mentoring should be a core competency of nurses prepared at the graduate level. Do you agree or disagree with this statement? Defend your response.
Based on your graduate specialization, identify one coaching activity that you can do in this advanced practice role. What strategies would you employ for this activity?
Describe one mentoring activity you might complete with a mentor that would help you to acclimate to your new advance practice role. Should this activity be structured or unstructured?

 

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Developing An Epidemiological Profile

“Dunn” In? An Epidemiological Profile

You are the sociologist for a medical investigation team. The purpose of this team is to gather information on patients who have recently died prematurely at Indianapolis-area hospitals. You have been on the team for about three months now, and the other members of the team, a pathologist, a forensic scientist, and a criminologist, are really beginning to respect and rely on your contributions to the team.

This week the team is investigating the death of a high-powered sales executive, Mr. Dunn, from an apparent heart attack at his home in an exclusive area of Indianapolis. He was 45 years old, and he was known to have diabetes. This investigation is being made at the request of his parents upon their return to Indianapolis from a Heart Association Walkathon in Hawaii. So far, you have uncovered several significant findings that you will use to prepare an epidemiological profile of the deceased.

Mr. Dunn was recruited eight years ago by the Oxford Company, a major pharmaceutical manufacturer, and offered significant financial incentives to join them. Company records show that he has been their top salesperson for the last six years. Oxford lured Mr. Dunn away from Meyer and Meyer, Inc., which is also in the pharmaceutical field. Mr. Dunn worked for them for more than ten years and was one of their top salespersons as well. Previous to these two jobs, Mr. Dunn spent a great deal of time researching and becoming familiar with the pharmaceutical field and making contacts in the industry while making sales calls for a small assortment of other pharmaceutical companies.

Mr. Dunn’s salary was based primarily on commissions. He was on the road almost 40 weeks out of the year and was living out of a suitcase most of the time. When he wasn’t meeting with clients, he was typing up reports and making sales projections, usually followed by visits to the hotel restaurant and bar. He did try to stay in contact with his family and a few friends in Indianapolis, usually calling them on his cell phone while waiting in traffic.

The team leader has assigned you the task of developing an epidemiological profile of the executive, i.e., listing the possible contributing factors to his death based upon the facts outlined in this scenario. Develop a profile with at least five (5) likely characteristics of the decedent.

 

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